{
  "Profile_Information": {
    "public_name": "Machine_Readable_Report_UT CHIP",
    "state": "UTAH",
    "formulary_name": "UT CHIP",
    "formulary_id": 22873,
    "formulary_version": 4,
    "formulary_effective_date": "10/01/2025"
  },
  "Drug_Information": [
    {
      "ndc": "00904676130",
      "ndc_label_name": "12 Hour Nasal Decongestant Solution 0.05 % Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00409568502",
      "ndc_label_name": "A-Methapred SOLUTION RECONSTITUTED 125 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409568401",
      "ndc_label_name": "A-Methapred SOLUTION RECONSTITUTED 40 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089715",
      "ndc_label_name": "Abacavir Sulfate Solution 20 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121089720",
      "ndc_label_name": "Abacavir Sulfate Solution 20 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722056224",
      "ndc_label_name": "Abacavir Sulfate SOLUTION 20 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980040524",
      "ndc_label_name": "Abacavir Sulfate Solution 20 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378410591",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020401",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862007360",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722055760",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904687406",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904687404",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020406",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268004911",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268004912",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084002121",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084002111",
      "ndc_label_name": "Abacavir Sulfate TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097051403",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380071703",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865016760",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865016701",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518127400",
      "ndc_label_name": "Abacavir Sulfate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097036202",
      "ndc_label_name": "Abacavir Sulfate-Lamivudine TABLET 600-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291011530",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573043030",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385096230",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862033530",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722083830",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180028806",
      "ndc_label_name": "Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148010280",
      "ndc_label_name": "Abilify Asimtufii Prefilled Syringe 720 MG/2.4ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148011492",
      "ndc_label_name": "Abilify Asimtufii Prefilled Syringe 960 MG/3.2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148011480",
      "ndc_label_name": "Abilify Asimtufii Prefilled Syringe 960 MG/3.2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148004580",
      "ndc_label_name": "Abilify Maintena Prefilled Syringe 300 MG Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148007280",
      "ndc_label_name": "Abilify Maintena Prefilled Syringe 400 MG Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148001871",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 300 MG Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148023212",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 300 MG Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148001870",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 300 MG Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148001970",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 400 MG Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148001971",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 400 MG Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59148024512",
      "ndc_label_name": "Abilify Maintena Suspension Reconstituted ER 400 MG Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219116507",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714096301",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407018112",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603011001",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093112589",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143959721",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378692078",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687045521",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079021",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205028492",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57894015512",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82249001012",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598035804",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904694804",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291002412",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079011",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021398",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907022404",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009013912",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679002101",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687045511",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505432701",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629942901",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462013508",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238116507",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001048907",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980041812",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205003092",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921017820",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606056601",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82293000110",
      "ndc_label_name": "Abiraterone Acetate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00135020003",
      "ndc_label_name": "Abreva Cream 10 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00135020001",
      "ndc_label_name": "Abreva Cream 10 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00135020005",
      "ndc_label_name": "Abreva Cream 10 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00135030001",
      "ndc_label_name": "Abreva Cream 10 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00135020006",
      "ndc_label_name": "Abreva Cream 10 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00069034405",
      "ndc_label_name": "Abrysvo Solution Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069034401",
      "ndc_label_name": "Abrysvo Solution Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069246519",
      "ndc_label_name": "Abrysvo Solution Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069246510",
      "ndc_label_name": "Abrysvo Solution Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069246501",
      "ndc_label_name": "Abrysvo Solution Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093535286",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462043518",
      "ndc_label_name": "Acamprosate Calcium TABLET DELAYED RELEASE 333 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291010418",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687012195",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378633380",
      "ndc_label_name": "Acamprosate Calcium TABLET DELAYED RELEASE 333 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904721304",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382056928",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135063632",
      "ndc_label_name": "Acamprosate Calcium TABLET DELAYED RELEASE 333 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687012125",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452035325",
      "ndc_label_name": "Acamprosate Calcium Tablet Delayed Release 333 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380076006",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085630",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135045590",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090582900",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291013290",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085672",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054014225",
      "ndc_label_name": "Acarbose TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085611",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085690",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013360",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085600",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085660",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012210",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013390",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155014901",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085655",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013330",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085678",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012211",
      "ndc_label_name": "Acarbose Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085430",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291013090",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135045390",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085400",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054014025",
      "ndc_label_name": "Acarbose TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380075806",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085455",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012010",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013160",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012011",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085490",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085460",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155014701",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013190",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085411",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013130",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085472",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085478",
      "ndc_label_name": "Acarbose Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380075906",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291013190",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135045490",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085511",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085560",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054014125",
      "ndc_label_name": "Acarbose TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012110",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155014801",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085500",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095109",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012111",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085590",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085530",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085578",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085555",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013230",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085572",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013260",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013290",
      "ndc_label_name": "Acarbose Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502020301",
      "ndc_label_name": "Ace Aerosol Cloud Enhancer",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005015",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746066901",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407066601",
      "ndc_label_name": "Acebutolol HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135063001",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291001001",
      "ndc_label_name": "Acebutolol HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005011",
      "ndc_label_name": "Acebutolol HCl CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559025501",
      "ndc_label_name": "Acebutolol HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746067001",
      "ndc_label_name": "Acebutolol HCl CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135063101",
      "ndc_label_name": "Acebutolol HCl CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559025601",
      "ndc_label_name": "Acebutolol HCl Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407066701",
      "ndc_label_name": "Acebutolol HCl Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58602073094",
      "ndc_label_name": "Acetaminophen 8 Hour Tablet Extended Release 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000031001",
      "ndc_label_name": "Acetaminophen Childrens TABLET CHEWABLE 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917001170",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917007135",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904672024",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536129229",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536141348",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536141347",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904673059",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904672080",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090531304",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864000110",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904672040",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904672060",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904672059",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904672051",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917006772",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904673061",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090535001",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483034150",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904673060",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864000104",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917004918",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917006773",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47682017564",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917001164",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53002053430",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090531301",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904673080",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47682017548",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864000111",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090553701",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483034110",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483034101",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289088012",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090725201",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864000103",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53598000310",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47682017513",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289088006",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090531303",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483034142",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896022220",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289088021",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864070699",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289088024",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47682017533",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55700094601",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53598000301",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090531302",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788807003",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289088060",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483034105",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289088097",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090527201",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57237034701",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289088015",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289088001",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788886305",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896020405",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55700094630",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896021901",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896020401",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896020420",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289088020",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896022201",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70010016101",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187029340",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896021920",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896021910",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896021905",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896021950",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289088030",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896022210",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70010016105",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187029350",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60760053440",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788887301",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788863603",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187029310",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289088050",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788807001",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205016550",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000031202",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788807002",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788887303",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000037301",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788863601",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57237034705",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788886302",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399102602",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000044601",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788807005",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000037305",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000037302",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788863602",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60760091050",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788886303",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789024120",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518280500",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788863605",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70795012001",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "82568000202",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788887302",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788886301",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205016530",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69618001101",
      "ndc_label_name": "Acetaminophen Extra Strength TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70795012025",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000003601",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205016524",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000037303",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788887305",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335153608",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335153605",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399802701",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335153603",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789024130",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70010016110",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789024160",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335153604",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789024150",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205016540",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335153609",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335153601",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789024101",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399102601",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399802702",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "82568000201",
      "ndc_label_name": "Acetaminophen Extra Strength Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536121277",
      "ndc_label_name": "Acetaminophen Infants Suspension 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536142677",
      "ndc_label_name": "Acetaminophen Infants Suspension 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800036088",
      "ndc_label_name": "Acetaminophen Junior Strength TABLET DISPERSIBLE 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904673151",
      "ndc_label_name": "Acetaminophen PM Tablet 500-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000041102",
      "ndc_label_name": "Acetaminophen PM Tablet 500-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000041101",
      "ndc_label_name": "Acetaminophen PM Tablet 500-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000041103",
      "ndc_label_name": "Acetaminophen PM Tablet 500-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800036089",
      "ndc_label_name": "Acetaminophen Rapid Tabs Child TABLET DISPERSIBLE 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121065700",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121065705",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121104700",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328003105",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904673870",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66689005499",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904731941",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033000255",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57237030416",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66689005401",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121104705",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033000205",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904731970",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033000250",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328003150",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328003199",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57237030412",
      "ndc_label_name": "Acetaminophen Solution 160 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60687057142",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904673971",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033000240",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121131400",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904732071",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121131411",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033000254",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121209400",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328003210",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60687057156",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328003299",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904732002",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328003250",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121209411",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60687075142",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66689005501",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60687075156",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033000210",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66689005599",
      "ndc_label_name": "Acetaminophen Solution 325 MG/10.15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904732103",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121197100",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904682076",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328003450",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121197121",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121314121",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328003499",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60687057124",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328003420",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121314100",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66689005699",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60687057137",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60687074024",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904732176",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033000220",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60687074037",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033000253",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033000230",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66689005601",
      "ndc_label_name": "Acetaminophen Solution 650 MG/20.3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959010100",
      "ndc_label_name": "Acetaminophen Suppository 120 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802073200",
      "ndc_label_name": "Acetaminophen SUPPOSITORY 120 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090000100",
      "ndc_label_name": "Acetaminophen Suppository 120 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802073233",
      "ndc_label_name": "Acetaminophen SUPPOSITORY 120 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802073230",
      "ndc_label_name": "Acetaminophen SUPPOSITORY 120 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187037312",
      "ndc_label_name": "Acetaminophen SUPPOSITORY 120 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802073032",
      "ndc_label_name": "Acetaminophen Suppository 650 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802073030",
      "ndc_label_name": "Acetaminophen Suppository 650 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959010903",
      "ndc_label_name": "Acetaminophen Suppository 650 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802073033",
      "ndc_label_name": "Acetaminophen Suppository 650 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440701020",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012330",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440701001",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440701006",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440701024",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012324",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904677361",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440701010",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536132706",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090026704",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440701050",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440701040",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012310",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012362",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135016313",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440701030",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289056301",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959030240",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012350",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536132701",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135082801",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135016314",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864007039",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012305",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289056330",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57237034610",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47682014548",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536132710",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864000101",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54348051030",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45861008501",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012360",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896010205",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60760045350",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090026703",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864000102",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483034010",
      "ndc_label_name": "Acetaminophen TABLET 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54738054801",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47682014513",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012365",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896010210",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187052800",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090278300",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43353043390",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090026702",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289056309",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47682014536",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012370",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518044404",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788882106",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959030212",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47682014564",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090597106",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65155010201",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090427300",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012390",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518216800",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518110102",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959030224",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483034001",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959030260",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518191500",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54348051012",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292055591",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399802401",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518185501",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54738054803",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090290700",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54738054850",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518324801",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289056350",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959030200",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399802402",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205045600",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57237034601",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959030230",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289056316",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399102502",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504010505",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959030220",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "82568000102",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335067403",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788882101",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959030295",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896010220",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399801401",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788882103",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54348051020",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896010410",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335184701",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69618001001",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53002046030",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896010420",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789026720",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000009201",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289056306",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518325300",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399285505",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000037401",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289056324",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189019730",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399802501",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518324800",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289056320",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789026730",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162225201",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518110101",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58864000256",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335080400",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "82568000103",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205045630",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289056360",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399102503",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267000340",
      "ndc_label_name": "Acetaminophen TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335067402",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896010201",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71610023865",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788882109",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335080402",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896010401",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399102501",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518110100",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "82568000101",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63739008702",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335184702",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518193000",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335184703",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335184709",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189024730",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399102506",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399802502",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189024771",
      "ndc_label_name": "Acetaminophen Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999032304",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950037416",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121050404",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121050405",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856007905",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856007902",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121050400",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121100800",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014103",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090021500",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383033706",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121050416",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014104",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383033705",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856007901",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121050440",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383007916",
      "ndc_label_name": "Acetaminophen-Codeine Solution 120-12 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121100812",
      "ndc_label_name": "Acetaminophen-Codeine Solution 300-30 MG/12.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383033913",
      "ndc_label_name": "Acetaminophen-Codeine Solution 300-30 MG/12.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121100840",
      "ndc_label_name": "Acetaminophen-Codeine Solution 300-30 MG/12.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383033912",
      "ndc_label_name": "Acetaminophen-Codeine Solution 300-30 MG/12.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025924",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005412",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629118501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629118701",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025920",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093005001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048301",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025912",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025902",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005452",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959020830",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025915",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025950",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233721",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025930",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380044801",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267022130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107005801",
      "ndc_label_name": "Acetaminophen-Codeine TABLET 300-15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025960",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850064101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959020815",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629294501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025901",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874025904",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850064105",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702015",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702620",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048423",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048403",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093015001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048401",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048462",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702081",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702610",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702630",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702020",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702085",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093015010",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702010",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702690",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702640",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702685",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702030",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702604",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048410",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702606",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702691",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544010015",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000164",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000104",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702612",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544003215",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702012",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702615",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233832",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634052680",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000190",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702660",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544003220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702650",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000102",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000160",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000184",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440702681",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107005901",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107005999",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000107",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000114",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000172",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000140",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000190",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233821",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000110",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000112",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000124",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006060",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000150",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001070",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10544010020",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000118",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000128",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000150",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157301",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006050",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006030",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000125",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000121",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001075",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157400",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006090",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090461004",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006020",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000140",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000142",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000160",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090461101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387100",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090461007",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193401",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000148",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193301",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001050",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520004",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090461000",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090461001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001060",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000100",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193307",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001090",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000325",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090461003",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520007",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520000",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157200",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001045",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079016120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157202",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000340",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520003",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436322707",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000316",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157203",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006024",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760093830",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193302",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000350",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079016101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000324",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000345",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193304",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002390",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193303",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002010110",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000390",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000360",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002010120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000300",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157204",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005360",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520002",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002010115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118056203",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060401",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760046630",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000302",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157207",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005371",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000328",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348001510",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118056206",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048490",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032830",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000306",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193300",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000342",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060411",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760058130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081530",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032871",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000315",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193500",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380044603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002330",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048430",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629118801",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048418",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000320",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090461002",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000124",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187010615",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020216",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020206",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081515",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000330",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000304",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000184",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187010630",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020224",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020210",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020212",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048410",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000310",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020228",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020250",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020215",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020214",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081560",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000312",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000275",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000110",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380044601",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020225",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020290",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020205",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000375",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783503",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000280",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000215",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020242",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000106",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020208",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000384",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000270",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850064205",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000112",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850064201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002010130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025608",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088272",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000250",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088250",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162003311",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162003310",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002371",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054502",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088275",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788950606",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000190",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000240",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000160",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032890",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054505",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088280",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000191",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000255",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000245",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081520",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054508",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788028503",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054507",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780106",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000272",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088245",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000254",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629149410",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011190",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010320",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783506",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000285",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088253",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000290",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082100",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780102",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000115",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000293",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020202",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783502",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804018130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088254",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025600",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088290",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020204",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082105",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054506",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425052901",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020218",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788028506",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874020240",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082110",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335152209",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425052902",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000140",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037211",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335152203",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025601",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000246",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082112",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011130",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025605",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000253",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518021200",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425052701",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025606",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088240",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082120",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011146",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054500",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088246",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518262800",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425052903",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054503",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088255",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082150",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011170",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335152202",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544088270",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025602",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011175",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335152205",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788950603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025607",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010303",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335152208",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518298900",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054509",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010330",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011154",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025604",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335181809",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025609",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005512",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054504",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011153",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011145",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005552",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011172",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011160",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162200105",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162200101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010310",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011180",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082190",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082160",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425052702",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425052703",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093035005",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000248",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000202",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406048505",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093035001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000256",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000212",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233928",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002690",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000221",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000208",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603233921",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093035010",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044600",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107006005",
      "ndc_label_name": "Acetaminophen-Codeine TABLET 300-60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044650",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000214",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107006099",
      "ndc_label_name": "Acetaminophen-Codeine TABLET 300-60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107006001",
      "ndc_label_name": "Acetaminophen-Codeine TABLET 300-60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044602",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000210",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044660",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000240",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000228",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002630",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090301101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044630",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002601",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629303101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000242",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000290",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358000200",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919047260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629303105",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304056101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002660",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380044702",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261000260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002640",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044624",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090560",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026708",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629303104",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044620",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000360",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061511",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061501",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629303103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026705",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000230",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026701",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026702",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000380",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919027390",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919047290",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026740",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026750",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000260",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026715",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026704",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047470",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629303102",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629119001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000220",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026760",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267100500",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026728",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026712",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780203",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026730",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026703",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000240",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026790",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037301",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850064305",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026720",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785901",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380044701",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63874026710",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000370",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000353",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037311",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047453",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785902",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047460",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850064301",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000390",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888203",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785906",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047480",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005612",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785903",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305100",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780202",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973601",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973602",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047490",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425052802",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973606",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184607",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335070103",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184600",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888106",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973609",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335070101",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780206",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184602",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053001",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162200205",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888206",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184605",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184601",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184603",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518276400",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184608",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184604",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425052801",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162200201",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184606",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005652",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053003",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425052803",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184609",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053002",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189037660",
      "ndc_label_name": "Acetaminophen-Codeine Tablet 300-60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135061260",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571024301",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729033101",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033003001",
      "ndc_label_name": "AcetaZOLAMIDE ER CAPSULE EXTENDED RELEASE 12 HOUR 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155012001",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687057821",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268004212",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090594500",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155078701",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313200",
      "ndc_label_name": "AcetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268004211",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687057811",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742023301",
      "ndc_label_name": "AcetaZOLAMIDE ER CAPSULE EXTENDED RELEASE 12 HOUR 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332034931",
      "ndc_label_name": "AcetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710159101",
      "ndc_label_name": "AcetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367020901",
      "ndc_label_name": "acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289072012",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291008901",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817020010",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090561701",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135083001",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090057701",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135077201",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004506",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629119401",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090451101",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954003330",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023801",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289072006",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672402201",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155028701",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81005010401",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162197801",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991088401",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930000812",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888004701",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135060712",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578014901",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651090501",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205030830",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380083306",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004512",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756072011",
      "ndc_label_name": "acetaZOLAMIDE Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527105001",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135083101",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578015001",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090559300",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155028801",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651090601",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090300300",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135056701",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904666361",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135060812",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162197901",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090753600",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291009001",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930000912",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023701",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005415",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135077301",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380083406",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672402301",
      "ndc_label_name": "AcetaZOLAMIDE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005411",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291010310",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81005010501",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817020110",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991088501",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999089212",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756072111",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061901",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084054111",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739025701",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061911",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954003430",
      "ndc_label_name": "AcetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629119501",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084054101",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888004801",
      "ndc_label_name": "acetaZOLAMIDE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00264230410",
      "ndc_label_name": "Acetic Acid SOLUTION 0.25 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990614322",
      "ndc_label_name": "Acetic Acid Solution 0.25 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264230400",
      "ndc_label_name": "Acetic Acid SOLUTION 0.25 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338065604",
      "ndc_label_name": "Acetic Acid SOLUTION 0.25 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990614309",
      "ndc_label_name": "Acetic Acid Solution 0.25 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090652700",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432074115",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090626300",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980042415",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090035100",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817081615",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383088915",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090302000",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700098615",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700042415",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135080151",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432074116",
      "ndc_label_name": "Acetic Acid Solution 2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00517761003",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00409330803",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00517760425",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323069022",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42494043625",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00409330811",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00517760401",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323069441",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323069222",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323069030",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323069444",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323069041",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323069404",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323069044",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069001925",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323069210",
      "ndc_label_name": "Acetylcysteine SOLUTION 20 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323069422",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069001901",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069002003",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069002001",
      "ndc_label_name": "Acetylcysteine Solution 20 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483072001",
      "ndc_label_name": "Acid Reducer Maximum Strength Tablet 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113019402",
      "ndc_label_name": "Acid Reducer Maximum Strength TABLET 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800019402",
      "ndc_label_name": "Acid Reducer Maximum Strength TABLET 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113019471",
      "ndc_label_name": "Acid Reducer Maximum Strength Tablet 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000071001",
      "ndc_label_name": "Acid Reducer Maximum Strength Tablet 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000004901",
      "ndc_label_name": "Acid Reducer Maximum Strength Tablet 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800019471",
      "ndc_label_name": "Acid Reducer Maximum Strength TABLET 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000050301",
      "ndc_label_name": "Acid Reducer Maximum Strength Tablet 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800014172",
      "ndc_label_name": "Acid Reducer TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113014165",
      "ndc_label_name": "Acid Reducer TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800014165",
      "ndc_label_name": "Acid Reducer TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056397",
      "ndc_label_name": "Acid Reducer TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58602070519",
      "ndc_label_name": "Acid Reducer Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58602070584",
      "ndc_label_name": "Acid Reducer Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58602070515",
      "ndc_label_name": "Acid Reducer Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000004801",
      "ndc_label_name": "Acid Reducer Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536105875",
      "ndc_label_name": "Acne Medication 10 Lotion 10 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536105775",
      "ndc_label_name": "Acne Medication 5 Lotion 5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08439620301",
      "ndc_label_name": "Activity Pouch",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440703081",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440703060",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904751961",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291001750",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440603060",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440603001",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440603005",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440703030",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155022901",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904578961",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291001701",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999038525",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999038510",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440603081",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090561001",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440703083",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090561007",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155022905",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090059501",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999038540",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573901",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082605",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407085201",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440703085",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721600",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090059507",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090059601",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090059600",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348062025",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090059500",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051750",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082650",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721601",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090059607",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002024560",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573900",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429001205",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573907",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002024535",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999038515",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721607",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051725",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505004206",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051730",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442011405",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919033130",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002024550",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090561000",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407085205",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002024525",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442011401",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051735",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304065201",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205024390",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060660",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187018290",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010701",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700065130",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135003950",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002024530",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000650",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028000",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000625",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518249601",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047009",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629200901",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304065205",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429001201",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205020990",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028003",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205057830",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028001",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170401",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518249600",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000640",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010711",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047000",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028005",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205057890",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028006",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170403",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047007",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205020950",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69076014601",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047005",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170402",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028002",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170405",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170404",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047008",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047001",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028008",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921014601",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162190801",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028004",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162190807",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162190809",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170400",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047006",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047003",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170407",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162190806",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028007",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162190808",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578000201",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288003901",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170409",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047004",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170408",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288003902",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028009",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170406",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834012401",
      "ndc_label_name": "Acyclovir CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804024590",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047002",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162190803",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162190802",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162190804",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162190800",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578000205",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241002805",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162190805",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789053650",
      "ndc_label_name": "Acyclovir Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714088502",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168082530",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378870006",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668051502",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378870049",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591115930",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578008206",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168082515",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332024830",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342043930",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668051501",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714088501",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342043915",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162083596",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090656100",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672136001",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63646030015",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629232701",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462074617",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079055068",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079055067",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578008201",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382099201",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332024815",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462074635",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629232801",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700010715",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672136002",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63646030030",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332024805",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70700010716",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162083594",
      "ndc_label_name": "Acyclovir OINTMENT 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162196002",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382099204",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788824701",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162196003",
      "ndc_label_name": "Acyclovir Ointment 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689034216",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135080347",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999080305",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155048551",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999080324",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954018810",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378871273",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472008216",
      "ndc_label_name": "Acyclovir SUSPENSION 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205017072",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383081016",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722068147",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135080305",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651049347",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135080324",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888007917",
      "ndc_label_name": "Acyclovir Suspension 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440603125",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440603101",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440603130",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155022701",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440603105",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722077701",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440603181",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063034005",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904579061",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440703130",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440703185",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356090340",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440703125",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092830",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904750761",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999008625",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722077705",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440703181",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063034004",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064203",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155022705",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092840",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063034060",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064202",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063034001",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063034040",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063034030",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064409",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063034025",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064204",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092805",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064500",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063034015",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092860",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092825",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325005",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092815",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064205",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064301",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090156702",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092804",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064402",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064206",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090684400",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999008600",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325003",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064403",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325009",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999008621",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090156704",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090156703",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727506",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064300",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325004",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064404",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727503",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999008690",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090156709",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325002",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727509",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064405",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727502",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090156705",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505530601",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064209",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727601",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325400",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407014505",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064406",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727505",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325006",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187025315",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064501",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054412",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325401",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054415",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727600",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002000815",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407014501",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820308",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090156706",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054425",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268006115",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505530608",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727700",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442011205",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054401",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872401",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727504",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687085611",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054440",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919065414",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268006111",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037030",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054421",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872408",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054430",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687085665",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054460",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010801",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054410",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776001",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002000830",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518211701",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054450",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000721",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700053935",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010811",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348062710",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518042703",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002000860",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205047215",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002000821",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382079105",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442011201",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776003",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348062715",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934055715",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700053940",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032303",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348062730",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776006",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452029020",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776005",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687085601",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934069430",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304050401",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173501",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187025330",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776008",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518042702",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367013701",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037014",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934069490",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000725",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804000530",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187025360",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820301",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518211702",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452029030",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919065430",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032300",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820303",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518245502",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820302",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820304",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934013130",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934051230",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267000715",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032305",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367013705",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934051245",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872404",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872402",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032301",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205037130",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382079101",
      "ndc_label_name": "Acyclovir TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173503",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518042700",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032306",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117001801",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872403",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032307",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032309",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776002",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189063114",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518330600",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288001801",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518042701",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872405",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173504",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288001802",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776004",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834012205",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934055760",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117001802",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518211700",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518133202",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173505",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205039125",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776007",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032302",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335105300",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335105304",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032304",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335105306",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335105302",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834012201",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776009",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027001",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335105303",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173502",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804000521",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820305",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173506",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518245501",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173507",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518245503",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934055730",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934069460",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205005630",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205047230",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032308",
      "ndc_label_name": "Acyclovir TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335105301",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335105308",
      "ndc_label_name": "Acyclovir Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440703381",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722077801",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155022801",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090063700",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440603301",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440603305",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440603381",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440603320",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063058930",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090633503",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722077805",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959067840",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155022805",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440603310",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440703320",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063058910",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090162402",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268006211",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090063703",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505530705",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063058950",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440703310",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440703385",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090657803",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090657800",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407014605",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090063802",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167803",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090063702",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063058935",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353093318",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442011301",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959067830",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002002730",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090657802",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757506",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090633500",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090063800",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090162400",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053035",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002002750",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002002760",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268006215",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792302",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090633502",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002002735",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090162403",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187057435",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135001950",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083535",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407014601",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843408",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002002720",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505530701",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002002710",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629917401",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167807",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687086701",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959067850",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117001901",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002002725",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760077835",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002002715",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267039930",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010901",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000335",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053030",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452029120",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442011305",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187057406",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687086711",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789503",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757505",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629917402",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167802",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452029130",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789505",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304050501",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187057425",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117001902",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792305",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382079201",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757508",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518251801",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843403",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167805",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167801",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335138106",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843404",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757504",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843402",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335138107",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518251800",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167808",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167804",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335138109",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367013805",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789504",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205038830",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162172402",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518333100",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267039935",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010911",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162172407",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335138102",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792303",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335138104",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162172409",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205005330",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382079205",
      "ndc_label_name": "Acyclovir TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757503",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804001230",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335138103",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792304",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162172406",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804001235",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205005335",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757502",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789502",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843405",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335138105",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757507",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189023230",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335138101",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335138100",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335255503",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367013801",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335138108",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162172403",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162172400",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288001902",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834012305",
      "ndc_label_name": "Acyclovir TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162172405",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834012301",
      "ndc_label_name": "Acyclovir TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934055635",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162172408",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934082835",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189023235",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205038835",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288001901",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162172401",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162172404",
      "ndc_label_name": "Acyclovir Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090107900",
      "ndc_label_name": "Adacel Suspension 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281040010",
      "ndc_label_name": "Adacel SUSPENSION 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281040058",
      "ndc_label_name": "Adacel SUSPENSION 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281040020",
      "ndc_label_name": "Adacel Suspension Prefilled Syringe 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281040089",
      "ndc_label_name": "Adacel Suspension Prefilled Syringe 5-2-15.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49502041602",
      "ndc_label_name": "Adalimumab-fkjp (2 Pen) Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502041702",
      "ndc_label_name": "Adalimumab-fkjp (2 Syringe) Prefilled Syringe Kit 20 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502041802",
      "ndc_label_name": "Adalimumab-fkjp (2 Syringe) Prefilled Syringe Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502041606",
      "ndc_label_name": "Adalimumab-fkjp Auto-Injector Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502041706",
      "ndc_label_name": "Adalimumab-fkjp Prefilled Syringe Kit 20 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502041806",
      "ndc_label_name": "Adalimumab-fkjp Prefilled Syringe Kit 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672214306",
      "ndc_label_name": "Adapalene Gel 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72657015855",
      "ndc_label_name": "Adapalene Gel 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000004301",
      "ndc_label_name": "Adapalene Gel 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000004302",
      "ndc_label_name": "Adapalene Gel 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "42546072045",
      "ndc_label_name": "Adapalene GEL 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536141220",
      "ndc_label_name": "Adapalene Gel 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672215006",
      "ndc_label_name": "Adapalene Gel 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72657015817",
      "ndc_label_name": "Adapalene Gel 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090200400",
      "ndc_label_name": "Adapalene Gel 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536141226",
      "ndc_label_name": "Adapalene Gel 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000066602",
      "ndc_label_name": "Adapalene Gel 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672214301",
      "ndc_label_name": "Adapalene Gel 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672215001",
      "ndc_label_name": "Adapalene Gel 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58118999904",
      "ndc_label_name": "Adapalene GEL 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794000308",
      "ndc_label_name": "Adefovir Dipivoxil TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505394703",
      "ndc_label_name": "Adefovir Dipivoxil Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00024592505",
      "ndc_label_name": "Admelog SoloStar Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00024592501",
      "ndc_label_name": "Admelog SoloStar Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00024592605",
      "ndc_label_name": "Admelog Solution 100 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00024592410",
      "ndc_label_name": "Admelog Solution 100 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24338011390",
      "ndc_label_name": "Adthyza Tablet 130 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24338001690",
      "ndc_label_name": "Adthyza Tablet 16.25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24338006590",
      "ndc_label_name": "Adthyza Tablet 65 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24338009790",
      "ndc_label_name": "Adthyza Tablet 97.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83490044079",
      "ndc_label_name": "Adult Aerosol Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83490044078",
      "ndc_label_name": "Adult Aerosol Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373081311",
      "ndc_label_name": "Adult Mask Large",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00944305402",
      "ndc_label_name": "Advate Solution Reconstituted 1500 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944304710",
      "ndc_label_name": "Advate Solution Reconstituted 4000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351066510",
      "ndc_label_name": "AeroEclipse EZ Twist Tubing",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351044050",
      "ndc_label_name": "AeroEclipse II Nebulizer",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351065850",
      "ndc_label_name": "AeroEclipse Mask Large",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "04351065950",
      "ndc_label_name": "AeroEclipse Mask Medium",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "04351065750",
      "ndc_label_name": "AeroEclipse Mask Small",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "04351052510",
      "ndc_label_name": "AeroTrach Plus",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33332042111",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332042210",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332042110",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332042310",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332042211",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332042311",
      "ndc_label_name": "Afluria Quadrivalent Suspension Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332032102",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332032303",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332032204",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332032101",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332032304",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33332032203",
      "ndc_label_name": "Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73796009921",
      "ndc_label_name": "AIRS Pediatric Aerosol Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714090702",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714090701",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162235902",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799011002",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162130904",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291009302",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591271202",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598045202",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629927801",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205005108",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722093502",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407025802",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710102106",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "78482011002",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629122101",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710102108",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097023772",
      "ndc_label_name": "Albendazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802008801",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00254100752",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781729685",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093317431",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097014260",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054074287",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067942",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993001968",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72572001401",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096301",
      "ndc_label_name": "Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154435905",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487950125",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378827093",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378827055",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378827052",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378827091",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378827031",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487950101",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135082884",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090051601",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335070352",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335070349",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335070354",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487950103",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090051600",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487950160",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION (2.5 MG/3ML) 0.083% INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204020060",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090340000",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862085825",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518261300",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687039583",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999034425",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090656000",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788770202",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839902",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090656001",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862085830",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204020025",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687039579",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204020001",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862085860",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204020030",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849202",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518241300",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204001001",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487030101",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 0.63 MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591346753",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651018325",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378699198",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378705752",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378705798",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378699152",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742039225",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135082684",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742039205",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204001055",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651018330",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378705852",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742039325",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378699298",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742039305",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487990401",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 1.25 MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378699252",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378705898",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651018425",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487990425",
      "ndc_label_name": "Albuterol Sulfate NEBULIZATION SOLUTION 1.25 MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651018430",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135082784",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204001101",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591346853",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204001155",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487990130",
      "ndc_label_name": "Albuterol Sulfate Nebulization Solution 2.5 MG/0.5ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959015303",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135018924",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383074016",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135018941",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135018905",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752010212",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999018924",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472082516",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959015306",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135018947",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335290701",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999018905",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206402",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959015309",
      "ndc_label_name": "Albuterol Sulfate Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407036801",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289004530",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489017705",
      "ndc_label_name": "Albuterol Sulfate TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980044301",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489017701",
      "ndc_label_name": "Albuterol Sulfate TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959090620",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440704630",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378057201",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135067290",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089930",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710106201",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089911",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543029110",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238134501",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084095295",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084095225",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089900",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089955",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089960",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089990",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834027401",
      "ndc_label_name": "Albuterol Sulfate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130601",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026345",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462030047",
      "ndc_label_name": "Alclometasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026315",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130606",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026360",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130603",
      "ndc_label_name": "Alclometasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462030065",
      "ndc_label_name": "Alclometasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462030017",
      "ndc_label_name": "Alclometasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026460",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026415",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131601",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131603",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029947",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026445",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131606",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029965",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029917",
      "ndc_label_name": "Alclometasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11917006104",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917003175",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917014455",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "19283059475",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917007088",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917012805",
      "ndc_label_name": "Alcohol Swabs PAD 70 %",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113200078",
      "ndc_label_name": "Alcohol Swabs Pad 70 %",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090788400",
      "ndc_label_name": "Alcohol Swabs Pad 70 %",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83017689503",
      "ndc_label_name": "Alcohol Swabs Pad 70 %",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00025103131",
      "ndc_label_name": "Aldactone TABLET 100 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00025100131",
      "ndc_label_name": "Aldactone TABLET 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00025104131",
      "ndc_label_name": "Aldactone TABLET 50 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242013001",
      "ndc_label_name": "Alecensa Capsule 150 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862032730",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980034003",
      "ndc_label_name": "Alendronate Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111058801",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071079030",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714063101",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980034001",
      "ndc_label_name": "Alendronate Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714063102",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111058830",
      "ndc_label_name": "Alendronate Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097022376",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135071844",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135069612",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111059048",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135071812",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135069644",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090407600",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714063201",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090109100",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097022316",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090547400",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071157704",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980034114",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282068145",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862032804",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714063202",
      "ndc_label_name": "Alendronate Sodium TABLET 35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543013004",
      "ndc_label_name": "Alendronate Sodium Tablet 35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071079130",
      "ndc_label_name": "Alendronate Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111058930",
      "ndc_label_name": "Alendronate Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111058901",
      "ndc_label_name": "Alendronate Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714063302",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518003301",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135069712",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135069744",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090232201",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135069720",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356059404",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135071944",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090258701",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862032904",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090232200",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135071912",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090469201",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004804",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090312601",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714063301",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090258700",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282068245",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097022476",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090469200",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567701",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090312600",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111059248",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567700",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788823504",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980034201",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097022416",
      "ndc_label_name": "Alendronate Sodium TABLET 70 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919068904",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518003300",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980034214",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788713004",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543013120",
      "ndc_label_name": "Alendronate Sodium Tablet 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668002105",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440500090",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440500001",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407082990",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335095688",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300015501",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440500030",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440500005",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094530",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074630",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094516",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237011490",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282030201",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300015519",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440500060",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440500081",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919034930",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094560",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335095681",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084407",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282030210",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862024901",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282030290",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668002101",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629235301",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162144909",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282030212",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074660",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629235401",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282030205",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629929501",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335095618",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084412",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505285009",
      "ndc_label_name": "Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462551000",
      "ndc_label_name": "All Flow 1000 PFT Filter",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69848000609",
      "ndc_label_name": "Allergy (Cetirizine) Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113046267",
      "ndc_label_name": "Allergy Relief CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113046262",
      "ndc_label_name": "Allergy Relief Capsule 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000020701",
      "ndc_label_name": "Allergy Relief Capsule 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000008501",
      "ndc_label_name": "Allergy Relief Capsule 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000058501",
      "ndc_label_name": "Allergy Relief Capsule 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800044983",
      "ndc_label_name": "Allergy Relief Capsule 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000020702",
      "ndc_label_name": "Allergy Relief Capsule 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800058544",
      "ndc_label_name": "Allergy Relief Childrens TABLET DISPERSIBLE 12.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917011742",
      "ndc_label_name": "Allergy Relief Childrens TABLET DISPERSIBLE 12.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113200760",
      "ndc_label_name": "Allergy/Congestion Relief Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800061165",
      "ndc_label_name": "Allergy/Congestion Relief Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00378013710",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603211521",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440705081",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440705085",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571088309",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714004110",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440705090",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378013701",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440705091",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714057602",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591554301",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603211532",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714004107",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013416",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714004112",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440705030",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571088310",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047300",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591554310",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300034905",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722025201",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063007990",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714057603",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090466204",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013401",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489015605",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704161",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722025210",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097520",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254403",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714057604",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090516803",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722025205",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111072901",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714057601",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063007960",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090516804",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090376004",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300034910",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090671600",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090671503",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700087990",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155069301",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079390",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700094790",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111072910",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079320",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429018018",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769604",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118211503",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155069310",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063093501",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760071090",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651028501",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097590",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067711",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020520",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074830",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300034901",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090783200",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135051631",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135051690",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090376003",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760013490",
      "ndc_label_name": "Allopurinol TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489015610",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584098811",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063007920",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268006315",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187046390",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739041010",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090466203",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760065690",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067701",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544098860",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063007930",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047330",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267066530",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402703",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769700",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073660",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074890",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788738303",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079360",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788738309",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544098880",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833706",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090783300",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833703",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584098801",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833701",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254404",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833709",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402706",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518045104",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489015601",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518045101",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073630",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315029105",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090671504",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335254202",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402709",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934020930",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629211101",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019480",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544098830",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019460",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769603",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094960",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788738301",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921024050",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267066560",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094980",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845801",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162114900",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090783201",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189043790",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872701",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267066590",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845806",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268006311",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315029101",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073674",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872706",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020501",
      "ndc_label_name": "Allopurinol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69967000803",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073680",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518045100",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651028599",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518167801",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402701",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518045102",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304053901",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710120900",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845803",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518045103",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304053910",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019430",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872709",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710120901",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167504",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019760",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315029110",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934007230",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845809",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205020830",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921024060",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921024001",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872703",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865030301",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865030310",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69967000801",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205020890",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019780",
      "ndc_label_name": "Allopurinol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378018105",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591554405",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571088550",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603211628",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378018101",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440705130",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904657261",
      "ndc_label_name": "Allopurinol TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440705160",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603211621",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722025305",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714004210",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714057702",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440705181",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440705191",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714057701",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440705185",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904261460",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735103",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090004400",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155069405",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440705190",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603211632",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155069401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591554401",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571088509",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735300",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090466300",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063077490",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035005",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013516",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035001",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097630",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714004211",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267022430",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090519401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999024503",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090688201",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722025310",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722025301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090519400",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013501",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959031160",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090186700",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268006415",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063077430",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090186701",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090519403",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035010",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315029205",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489015705",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020601",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289001090",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097690",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735101",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090688200",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063093401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69967000902",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111073005",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651028605",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700093590",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008860",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651028601",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959031130",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018660",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004930",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289001001",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135051731",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068801",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090004403",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267022490",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111073001",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090186703",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090466301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289001003",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629211301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544037130",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090688203",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544037160",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760098990",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090466303",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090696800",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700054090",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267022460",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871303",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735100",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886503",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919047190",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020620",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268006411",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304054001",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842409",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023160",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489015710",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315029210",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584071311",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959031100",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289001030",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788754203",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518180602",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025360",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068811",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518180600",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187024090",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489015701",
      "ndc_label_name": "Allopurinol TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919047130",
      "ndc_label_name": "Allopurinol TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518157302",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710121005",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921024260",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135051790",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518180601",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304054005",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760013990",
      "ndc_label_name": "Allopurinol TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544031360",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518328900",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934050430",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020602",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788754209",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205037790",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629211201",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584071301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886501",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006445",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162115000",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886506",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006460",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739079610",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518157300",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068145",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162115005",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871309",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068160",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921024250",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788754201",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69967000901",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038302",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921024201",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865030405",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710121001",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836403",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865030401",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020601",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189041790",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836409",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189064790",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425051802",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842403",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886509",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315029201",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518157301",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425051801",
      "ndc_label_name": "Allopurinol Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68455010851",
      "ndc_label_name": "Aloe Vesta Antifungal Ointment 2 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68455010852",
      "ndc_label_name": "Aloe Vesta Antifungal Ointment 2 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802010365",
      "ndc_label_name": "Alogliptin Benzoate Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066109",
      "ndc_label_name": "Alogliptin Benzoate Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066118",
      "ndc_label_name": "Alogliptin Benzoate Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090557400",
      "ndc_label_name": "Alogliptin Benzoate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030060",
      "ndc_label_name": "Alogliptin Benzoate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030009",
      "ndc_label_name": "Alogliptin Benzoate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802015065",
      "ndc_label_name": "Alogliptin Benzoate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030018",
      "ndc_label_name": "Alogliptin Benzoate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802008765",
      "ndc_label_name": "Alogliptin Benzoate Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802021172",
      "ndc_label_name": "Alogliptin-metFORMIN HCl Tablet 12.5-1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090599300",
      "ndc_label_name": "Alogliptin-metFORMIN HCl Tablet 12.5-1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802016972",
      "ndc_label_name": "Alogliptin-metFORMIN HCl Tablet 12.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802023865",
      "ndc_label_name": "Alogliptin-Pioglitazone Tablet 12.5-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802026065",
      "ndc_label_name": "Alogliptin-Pioglitazone Tablet 12.5-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802030465",
      "ndc_label_name": "Alogliptin-Pioglitazone Tablet 12.5-45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802035165",
      "ndc_label_name": "Alogliptin-Pioglitazone Tablet 25-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802040265",
      "ndc_label_name": "Alogliptin-Pioglitazone Tablet 25-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802049965",
      "ndc_label_name": "Alogliptin-Pioglitazone Tablet 25-45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707006",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035730",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781106110",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070530",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707090",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202710",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202796",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707060",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707030",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035770",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070560",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187091630",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035760",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202750",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035753",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035715",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781106101",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070515",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090225600",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067699",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090525700",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781106105",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073470",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070553",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070405",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070570",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003311",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966701",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003315",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090225604",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841402",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070410",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700067160",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090186400",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032110",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008706",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032100",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070401",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011230",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032102",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073453",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090225601",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032160",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041445",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032114",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032120",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011260",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041470",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335157601",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762371903",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762371901",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073415",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032190",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032130",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687037711",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762371904",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011270",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067601",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267021990",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687037701",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041453",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267021960",
      "ndc_label_name": "ALPRAZolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041430",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067605",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008730",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041415",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073430",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041480",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073445",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041460",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759402",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073460",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789015130",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073480",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841406",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004230",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759403",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759406",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841409",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759409",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841403",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069645",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069630",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029030",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789015106",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205071830",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804002730",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966705",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011253",
      "ndc_label_name": "ALPRAZolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035860",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035892",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202910",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707130",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202950",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707190",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707110",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107705",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035880",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055580",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707160",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035845",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228202996",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107701",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107710",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035853",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055530",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090507802",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707191",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999003260",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707103",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055545",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035870",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055520",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055560",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436463502",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035830",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090278101",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707106",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055575",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090278103",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055570",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055592",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070501",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055515",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090507803",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035820",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090507801",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090507800",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526101",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045715",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038811",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055553",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070510",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035875",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526100",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045700",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003415",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045720",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067701",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055590",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045728",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055555",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526103",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039505",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045742",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045730",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067799",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090175901",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039510",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999003215",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003411",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372003",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045745",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772600",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041580",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045790",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092930",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090175900",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436463501",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084930",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772602",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772601",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839809",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038801",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372004",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090175902",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070505",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067705",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772607",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041520",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335084905",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772603",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041515",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526102",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045760",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041592",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759502",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041530",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109206",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772608",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109202",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045702",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039515",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839806",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759508",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966601",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073430",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772609",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044230",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039520",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039530",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841003",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065230",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073460",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073445",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041575",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109205",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772604",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372001",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966602",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073453",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073470",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073480",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071201509",
      "ndc_label_name": "ALPRAZolam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044202",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772605",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629772606",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966605",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002406",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041553",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041545",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759506",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002460",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073415",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041560",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009902",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031330",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189024030",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041570",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839803",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028401",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002430",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759503",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841009",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028402",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002490",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759509",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205028430",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841006",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031390",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044290",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335084906",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016102",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073475",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031306",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031360",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804003530",
      "ndc_label_name": "ALPRAZolam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203150",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707230",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035960",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203196",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707291",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999025230",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203110",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107910",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060930",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107901",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035980",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781107905",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060940",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242503",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707290",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356074430",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035970",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060990",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035990",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035945",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035953",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052402",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060960",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356074460",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035975",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003511",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090289601",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057270",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057230",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052428",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035930",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057215",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057253",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008930",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090525801",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090289603",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057290",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052460",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242501",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057280",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057260",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008960",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118060509",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090525803",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242502",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372101",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090289602",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436463603",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057275",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034790",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000745",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003515",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436463601",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372104",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070601",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070610",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090525802",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759603",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034730",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052400",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436463602",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760067830",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052414",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052406",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429050415",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839406",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034753",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052410",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070605",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067801",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052430",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063960",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429050418",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022710",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839402",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052490",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000630",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067899",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034715",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759602",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083690",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022730",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839408",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372103",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187044330",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000715",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034755",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759608",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067805",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966003",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189021330",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760055030",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000775",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759606",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966008",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061402",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034745",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011360",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032830",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000660",
      "ndc_label_name": "ALPRAZolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034770",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759609",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044360",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061430",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034780",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189021360",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034775",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083630",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638101",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518325900",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839409",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335138605",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839403",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032860",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966001",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544000755",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518278500",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966004",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966002",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966000",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425044401",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010001",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966007",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544034760",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425044402",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966009",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011353",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966005",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001030",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425011002",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010002",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011330",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966006",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011370",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044330",
      "ndc_label_name": "ALPRAZolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781108905",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526201",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086460",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052360",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707360",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228203910",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086490",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086410",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070701",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086430",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372203",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335189404",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707390",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781108901",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052301",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761302",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335189403",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086440",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067905",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335189407",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090281901",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991070705",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067901",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057660",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335189406",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052340",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335189401",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189005860",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086400",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057690",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056491",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761306",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012160",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335189402",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761303",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335189405",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052330",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189045060",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052390",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762372201",
      "ndc_label_name": "ALPRAZolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761309",
      "ndc_label_name": "ALPRAZolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70515071201",
      "ndc_label_name": "Alvesco Aerosol Solution 160 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70515071205",
      "ndc_label_name": "Alvesco Aerosol Solution 160 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70515071105",
      "ndc_label_name": "Alvesco Aerosol Solution 80 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70515071101",
      "ndc_label_name": "Alvesco Aerosol Solution 80 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832101500",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571083450",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704259",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291012550",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707504",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707520",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707506",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440707510",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832101550",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268103",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704261",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687042201",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704206",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527170401",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527170405",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155036205",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135069301",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001520",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543049301",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760077930",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155036201",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135069305",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704240",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094705",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571083401",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382051205",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000730",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022320",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353085318",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000714",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000710",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268006915",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543049305",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189065730",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687042211",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268102",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268006911",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000720",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000715",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335291901",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332024631",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000760",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268101",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162240805",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135060990",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001514",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452014220",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382051201",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335295901",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266406",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268104",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73152007605",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332024671",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452014230",
      "ndc_label_name": "Amantadine HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73152007601",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189041230",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162240801",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205070220",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804019620",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003301",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003330",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003305",
      "ndc_label_name": "Amantadine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00116401016",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00116401010",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00116401041",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121064616",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328053016",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003614",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121064610",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383080712",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383080710",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383080716",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079742",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135001124",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135001047",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079756",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328053010",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135001159",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328053099",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003611",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432009316",
      "ndc_label_name": "Amantadine HCl Solution 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378427193",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407059530",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884035462",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505455303",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884035411",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794005208",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591240630",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710118003",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097038702",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009014230",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335023783",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651049530",
      "ndc_label_name": "Ambrisentan Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505455203",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651049430",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335023683",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378427093",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097038602",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407059430",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884035311",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591240530",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009014130",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794005108",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710117903",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884035362",
      "ndc_label_name": "Ambrisentan Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884011710",
      "ndc_label_name": "AMILoride HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884011701",
      "ndc_label_name": "AMILoride HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429027501",
      "ndc_label_name": "aMILoride HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574029201",
      "ndc_label_name": "AMILoride HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629211401",
      "ndc_label_name": "aMILoride HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794000502",
      "ndc_label_name": "aMILoride HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378057701",
      "ndc_label_name": "aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090051301",
      "ndc_label_name": "aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555048302",
      "ndc_label_name": "aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378057705",
      "ndc_label_name": "aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555048305",
      "ndc_label_name": "aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335088104",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781120392",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714084401",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904699361",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185014460",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090301502",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185014405",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035916",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003905",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035905",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090301501",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714084402",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356000110",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043711",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356000190",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739005110",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576602",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672402502",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407087490",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576601",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672402504",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862073205",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407087405",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518193901",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907000660",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862024190",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043701",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382022705",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862024105",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003960",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518193900",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335088102",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862024160",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382022714",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135057760",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335194202",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862073260",
      "ndc_label_name": "Amiodarone HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518324600",
      "ndc_label_name": "Amiodarone HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781148610",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090003006",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709085",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571010510",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788007701",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709030",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709081",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714044601",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571010501",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090398606",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603221221",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090302606",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030653",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781148601",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788007710",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041901",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714044602",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000840",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603221232",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090617901",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090003000",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729017101",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714025701",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999020560",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003715",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000850",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729017117",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742407",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090003001",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090302600",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714025702",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760055615",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002049130",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002049100",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041910",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003711",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090398600",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090398601",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030630",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919001130",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664068718",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002049160",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090302601",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000890",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000815",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090617907",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030660",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919001160",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760055690",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821806",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090302607",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760021215",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000860",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742401",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030680",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919011730",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919011760",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518153802",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742400",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788632003",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289012430",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407079301",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090617900",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001860",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518153800",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963701",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000802",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518153804",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700064390",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000820",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090617906",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405403",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518153801",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071030",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700064330",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518153805",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187063730",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289012412",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742406",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405406",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518362101",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888006700",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405409",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075060",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629211501",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664068788",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407079310",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038801",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710122501",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069390",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821809",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038601",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788632006",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760021290",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000830",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071060",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963700",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017201",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038810",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075053",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788632009",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919001190",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629211601",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038603",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963703",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788632008",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710122500",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756020111",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075080",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071053",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001890",
      "ndc_label_name": "Amitriptyline HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069301",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888006701",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069360",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934033130",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804009230",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189043160",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821803",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069330",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963704",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189043190",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518153803",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017202",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756020112",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038602",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335039503",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008000330",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071080",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008000390",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075030",
      "ndc_label_name": "Amitriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405203",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709490",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709481",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781149001",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356074130",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709485",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788008101",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714026101",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838003",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054221",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714045001",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729017501",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090641802",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603221621",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300042301",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090758302",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838008",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054228",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090398502",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090356402",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700066030",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571010901",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054230",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054240",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518150500",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760090790",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268004111",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022390",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022360",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090033302",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664069088",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056090",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069701",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629211701",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054215",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788689909",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405206",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268004115",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022330",
      "ndc_label_name": "Amitriptyline HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838009",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028701",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405208",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054242",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710122901",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405209",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407079701",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788689903",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518150501",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008004530",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838006",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760073290",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335237404",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788689906",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054214",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788689908",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756020511",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005830",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335237402",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335237407",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335237405",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335237401",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004001",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367039201",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189058130",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335237406",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069760",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043901",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888007101",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028702",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335237403",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043902",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023930",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028703",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335237408",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023960",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069790",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069730",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023990",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043903",
      "ndc_label_name": "Amitriptyline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781149101",
      "ndc_label_name": "Amitriptyline HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518225800",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729017601",
      "ndc_label_name": "Amitriptyline HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300042401",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788008201",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603221721",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571011001",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714026201",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037430",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189062230",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367039301",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664069188",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714045101",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407079801",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189058830",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069890",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037445",
      "ndc_label_name": "Amitriptyline HCl TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069830",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888007201",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629211801",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710123001",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518225801",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756020611",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069860",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069801",
      "ndc_label_name": "Amitriptyline HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709190",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709185",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709194",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709130",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714025801",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709181",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709160",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603221321",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603221332",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781148710",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788007810",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904741061",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714044701",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709191",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709192",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729017217",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788007801",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904020161",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634040171",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729017201",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999006350",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086330",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781148701",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086328",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090400501",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571010601",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300042010",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082230",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090003108",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353016353",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904718461",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090284000",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090400504",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571010610",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090400500",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353016330",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090631308",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090003100",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090284001",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090692500",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090631304",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714025802",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090631300",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090400508",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090692501",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090003101",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002033900",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727101",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003811",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714044702",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727100",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727300",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090692504",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407079410",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043311",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727108",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407079401",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300042001",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003815",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090751300",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034802",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034830",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028990",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436307205",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034820",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353016360",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436307201",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034890",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034814",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060030",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001991",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034812",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034850",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090003104",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436307202",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002033930",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060090",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187040890",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710122601",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034815",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043301",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090284008",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002033960",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664068818",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118211306",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834603",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335030602",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034860",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187040815",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090631301",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036730",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118211406",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001914",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869101",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963302",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664068888",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834601",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090692508",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760068590",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187040814",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267001960",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869103",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069560",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118211403",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834604",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090692700",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028960",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187040830",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788682508",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518364101",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075180",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028930",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518148400",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727104",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629211901",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187040860",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788682509",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335125404",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888006801",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629136910",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335239703",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034800",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788682506",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267100600",
      "ndc_label_name": "Amitriptyline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869104",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963301",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039503",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629212001",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070330",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034810",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756020212",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834608",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335125402",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963304",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934007130",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038901",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042060",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060060",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070353",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869106",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335276906",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069430",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075130",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710122600",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028503",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036700",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075153",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869109",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888006800",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425021203",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075160",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335125406",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023730",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760083830",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042030",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038910",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069401",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804010030",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042090",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963303",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425021201",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788682503",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008000430",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518148401",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039502",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834606",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008000490",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023760",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834609",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518408800",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756020211",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069460",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028502",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335030604",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069490",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335239706",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425021202",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963306",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039501",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069530",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070360",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030530",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023790",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028501",
      "ndc_label_name": "Amitriptyline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709292",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709291",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709230",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781148810",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709281",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714025902",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709294",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603221421",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353016430",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904020261",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709260",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788007910",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781148801",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353016460",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714025901",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090026405",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090026402",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904741161",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709285",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063083630",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788007901",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090297200",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714044801",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090631502",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255300",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571010701",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709290",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999022800",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300042110",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090718300",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729017317",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090718301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090718305",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571010710",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603221432",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090026400",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255302",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759800",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300042101",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407079501",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003911",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714044802",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904718561",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090026401",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090631505",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759802",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353016453",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051490",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436371001",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729017301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090631501",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255305",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436307301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759805",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700061990",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760068690",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090631500",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090718302",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759901",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051401",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051420",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759801",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687044411",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007660",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268003915",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919001360",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436307302",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051410",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051421",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759900",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267002060",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836308",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898701",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187035930",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700061960",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051430",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007630",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759902",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836303",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836309",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706109",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629212101",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518163301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051460",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919024060",
      "ndc_label_name": "Amitriptyline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759905",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876703",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664068988",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518163300",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836306",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071129",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007690",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898703",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407079510",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876706",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187015530",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071160",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876709",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044030",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629212201",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876708",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051400",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075230",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706103",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044090",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367039001",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888006900",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706108",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518049301",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700061930",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023860",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367039010",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023890",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069530",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023830",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710122700",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710122701",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664068918",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013701",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756020311",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069501",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043401",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043402",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756020312",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205082330",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687044401",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069590",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963503",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036602",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043403",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008002730",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963504",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075253",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898702",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425036201",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071130",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706106",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075260",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518163302",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069560",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335249101",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075280",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888006901",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006990",
      "ndc_label_name": "Amitriptyline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788008001",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709330",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729017401",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709381",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571010801",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781148901",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714026001",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709385",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999090960",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603221521",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664069288",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268004011",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714044901",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959028430",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629212301",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700068930",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959028400",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888007001",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629359705",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407079601",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300042201",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788643208",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788643201",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833909",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760018130",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804004830",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788643203",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919054190",
      "ndc_label_name": "Amitriptyline HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268004015",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833901",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788643206",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878803",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788643209",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833906",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959028460",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518257000",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833908",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878801",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833903",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878808",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518397900",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878806",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367039101",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756020411",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335017301",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710122801",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069630",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878809",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189030930",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205046630",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008004330",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335239802",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044430",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069601",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069660",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420069690",
      "ndc_label_name": "Amitriptyline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00276070930",
      "ndc_label_name": "Amladex Tablet Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714381",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714385",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642700",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714390",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090141800",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090141801",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714330",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291001401",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090513700",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090513701",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518256600",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845403",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034105",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058605",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736100",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642701",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014601",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736101",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789028501",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789041290",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058601",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180047201",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034101",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881803",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026090",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816803",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919085290",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789050290",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001013000",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272000",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111058601",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291001501",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090146300",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090538900",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155092501",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058705",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090328500",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058701",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014701",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180047301",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001013100",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 10-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677001301",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 10-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058301",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001013300",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291001101",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714190",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518192800",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714185",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714130",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090103900",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111033905",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518242100",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714181",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090677000",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180075601",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090540400",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518330300",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014301",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111033901",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058305",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789043290",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714230",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155092201",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090104201",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090618501",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714285",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714281",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034005",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090104101",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291001201",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034001",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090428400",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440714290",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014401",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090104200",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090428401",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058405",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180045901",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012230",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090618500",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162236001",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058401",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001013400",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090335700",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090304900",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090535700",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090340400",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291001301",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014501",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164400",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001013500",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111058701",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518303000",
      "ndc_label_name": "amLODIPine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058501",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862058505",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl CAPSULE 5-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046301",
      "ndc_label_name": "Amlodipine Besy-Benazepril HCl Capsule 5-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480716810",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052603",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300039819",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709890",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509830",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509800",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509881",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509805",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135076110",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052610",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291002790",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904637161",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509885",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509890",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090258102",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509860",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024305",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135076190",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090152901",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024310",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709881",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709830",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407095190",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709885",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291002710",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004130",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959020990",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004190",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582031518",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300039805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005713",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480716898",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069160",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353053430",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005718",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090680900",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005709",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762213509",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090535400",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098945",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760013290",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760013230",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005710",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353053445",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645051654",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052690",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090535401",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090258100",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760044530",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187091430",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353053460",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069130",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518263202",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024319",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090555000",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111027190",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046030",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862010390",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098930",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098960",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335094502",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300039810",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407095110",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760045930",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919080590",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877090210",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090680800",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090152900",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062030",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582031509",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700054130",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187032690",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544099331",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180072109",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090680801",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090535402",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062045",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090258101",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005799",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862010305",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638603",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788408503",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664057013",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090680802",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083045",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762213501",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049601",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845103",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798509",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584002309",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664057018",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919080530",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093853",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919078230",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049611",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854303",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845109",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093014803",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664057099",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180072103",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093860",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019910",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760045990",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518263201",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854306",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021804",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760061430",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382012305",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097845",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071070730",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019905",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934033090",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854309",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092830",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046090",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382012316",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098830",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071134900",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645058054",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093014806",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012815",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051630",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919078290",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788408506",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189052990",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638601",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788408501",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205050690",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584002350",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804016490",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187091490",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788408509",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584002393",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638606",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021802",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021801",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046953",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097190",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862010399",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638609",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083060",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335094503",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026230",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584002390",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019990",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798503",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282023990",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518263200",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335094501",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335094506",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097130",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518263203",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798501",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798506",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335186501",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006730",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845101",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335186502",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062035",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205048890",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845106",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083805",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083030",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205050630",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854301",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046945",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092845",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335094504",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934033030",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083815",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097830",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335094507",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335094505",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046960",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097853",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046930",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062080",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150011510",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097860",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092860",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189052930",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062060",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026260",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093845",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026290",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021803",
      "ndc_label_name": "AmLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051695",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026295",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051690",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093830",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282023910",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282050910",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097111",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092853",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009002810",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097100",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097160",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097155",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008003990",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098845",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008003930",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282050990",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097172",
      "ndc_label_name": "amLODIPine Besylate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709681",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509660",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509630",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709630",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509681",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480008305",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509605",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509600",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052405",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709685",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709690",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024105",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480008398",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052410",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904636961",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509685",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582031318",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300039610",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005509",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300039605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052403",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024119",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052490",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135075910",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664056899",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291002510",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090162702",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685300",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300039619",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063076430",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135075990",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024110",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762224203",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090162701",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005518",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959091090",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005505",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180071909",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877090010",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582031309",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862010190",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762224209",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078390",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111026990",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090162703",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788725903",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382012105",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005510",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788408203",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919075390",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005599",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078310",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788725906",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788408206",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005513",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788725901",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019710",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788408201",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862010199",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788826309",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767901",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788826301",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664056813",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767909",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180023301",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382012116",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096960",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767906",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788826306",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078330",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093014605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083615",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012615",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788408209",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282050710",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788826303",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150011310",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862010105",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096900",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584002109",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335083302",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788725909",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584002150",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093014603",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026090",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019790",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073230",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584002190",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282023710",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767903",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073245",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053560",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096972",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877090090",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518197101",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073260",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073215",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180023302",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026095",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051495",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073253",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083605",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282023790",
      "ndc_label_name": "AmLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096955",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096930",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518197100",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009002610",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008230",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096990",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282050790",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009002690",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096911",
      "ndc_label_name": "amLODIPine Besylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509760",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709730",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024210",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509785",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509705",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509700",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509730",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709785",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709790",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052590",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356005960",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480716710",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509781",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440709781",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440509790",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052505",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052503",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300039719",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063056430",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904637061",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582031418",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024219",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480716798",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135076090",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052510",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582031409",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005613",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135076010",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025145",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300039710",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300039705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024205",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005605",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025115",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687048811",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356005930",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090252400",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291002610",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090252402",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356074010",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353068415",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025130",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862010299",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005610",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090252401",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063056490",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687601",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005609",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353068445",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353068430",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645051554",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959091130",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655005225",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054545",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687700",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025160",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353068460",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090152701",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862709",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762201003",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862010205",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687602",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700054330",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090152700",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687600",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090287600",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584002209",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081460",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584002290",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407095010",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005699",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084490",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407095090",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090505900",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584002250",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084460",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518083502",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005618",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862010290",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019805",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700054390",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959091190",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934007590",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084471",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934028830",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762201001",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180045502",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382012205",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664056913",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687048801",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088830",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518027401",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093014706",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919029571",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180072009",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831306",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664056999",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919029530",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095645",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518298102",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068715",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180045501",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831303",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862701",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762201009",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071072830",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051530",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335235902",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072260",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180072003",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150011490",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862703",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084430",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518027400",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097030",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053960",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088845",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831301",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584002295",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862706",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019810",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068730",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097055",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088815",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095630",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012705",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518191400",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518037602",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877019890",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069145",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097072",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095660",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189052030",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012715",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518298103",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518298100",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877090190",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069160",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008003530",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026195",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009002710",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518037601",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189052090",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205059930",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071134800",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072230",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097000",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051595",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382012216",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518298101",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097011",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088860",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831309",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072245",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097060",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282050890",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083705",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934007530",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097090",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026130",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083715",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026160",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518037600",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068745",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093014703",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282023810",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205059630",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072215",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205059690",
      "ndc_label_name": "AmLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282050810",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205059990",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098560",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069130",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051590",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026190",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282023890",
      "ndc_label_name": "amLODIPine Besylate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386008203",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342028010",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020630",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862073990",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180076506",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342028007",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378172293",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862073930",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084503",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386008209",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084509",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407077330",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020690",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342028207",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386008003",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378172493",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084703",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320900",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084709",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386008009",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020830",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342028210",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407077430",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862074090",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862074030",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090247100",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180076706",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 10-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020890",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 10-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407077130",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378172193",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342027910",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084403",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386008303",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862073730",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020530",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084409",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342027907",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386008309",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862073790",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180076406",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 5-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020590",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862073830",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-320 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342028107",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407077230",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084609",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386008103",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378172393",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-320 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020730",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-320 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084603",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020790",
      "ndc_label_name": "Amlodipine Besylate-Valsartan TABLET 5-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342028110",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862073890",
      "ndc_label_name": "amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180076606",
      "ndc_label_name": "Amlodipine Besylate-Valsartan Tablet 5-320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130104",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802051377",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904598348",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672130102",
      "ndc_label_name": "Ammonium Lactate Cream 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629860801",
      "ndc_label_name": "Ammonium Lactate Cream 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802049338",
      "ndc_label_name": "Ammonium Lactate Cream 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802049326",
      "ndc_label_name": "Ammonium Lactate Cream 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629860901",
      "ndc_label_name": "Ammonium Lactate Cream 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518244900",
      "ndc_label_name": "Ammonium Lactate Cream 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130100",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802049383",
      "ndc_label_name": "Ammonium Lactate Cream 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162141302",
      "ndc_label_name": "Ammonium Lactate Cream 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71085007203",
      "ndc_label_name": "Ammonium Lactate Cream 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71085007204",
      "ndc_label_name": "Ammonium Lactate Cream 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63044040420",
      "ndc_label_name": "Ammonium Lactate CREAM 12 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399049404",
      "ndc_label_name": "Ammonium Lactate Cream 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904598426",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802052555",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802052526",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802041926",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162140704",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904598463",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162140702",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802041954",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130009",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63044048409",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672130005",
      "ndc_label_name": "Ammonium Lactate LOTION 12 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090658700",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71399014008",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629861001",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629861101",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71399014004",
      "ndc_label_name": "Ammonium Lactate Lotion 12 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440710009",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959001121",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093310705",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710003",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710006",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781202001",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093310701",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063057421",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582021310",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959001130",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710004",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710030",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781202005",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781202076",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289001921",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001604",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959001140",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348054530",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063057406",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714029802",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714029801",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582021318",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629422601",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090028800",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289001924",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781203",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090182601",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063057404",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237003005",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063057430",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788636903",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959001124",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267002121",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72508022505",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436721803",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063057415",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824003",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090182600",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824002",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289001915",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518218800",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007430",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959001160",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959001120",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934040721",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289001930",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72508022501",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289001960",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002020830",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289001940",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001605",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289001906",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788636902",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687077601",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007782",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267002115",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687077611",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237003001",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001601",
      "ndc_label_name": "Amoxicillin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934015494",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007404",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135082401",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007406",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007701",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934008730",
      "ndc_label_name": "Amoxicillin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143993905",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710109",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710130",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093310905",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781261305",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093310953",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093310906",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093310901",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063056308",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082008",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582021410",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781261301",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781261376",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710103",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710106",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710104",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063056321",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082014",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082004",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571023401",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082020",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714029902",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714029904",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582021418",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063056330",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082028",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082006",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063056306",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082040",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714029903",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063056356",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063056314",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082015",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082030",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001520",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063056309",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090030101",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571023405",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082050",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090030100",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082021",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151205",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090030107",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063056340",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090030204",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063056315",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082056",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090030102",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063091530",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151206",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151100",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063056360",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151105",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063056328",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001508",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090030205",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090030207",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151400",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151102",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063056363",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090179401",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001506",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090179505",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090030400",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090030301",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090179400",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151204",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001542",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090181001",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090030105",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090179506",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151101",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151207",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090179700",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090179402",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001545",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090181105",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090030300",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090179600",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151107",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151301",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090181201",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090181000",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090030206",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090181107",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151300",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002028",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090181104",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090179405",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090181300",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090181200",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090179504",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002018",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090179601",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289002024",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090181106",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090179407",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021630",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002060",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090181002",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002020",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090181005",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187004430",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002004",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090179507",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289002004",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021615",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655089452",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002040",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002005",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003321",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002006",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318700",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289002009",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021640",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002000",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021642",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002021",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005493",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002030",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021621",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289002042",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289002050",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021660",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348055006",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002024",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005494",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959002042",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289002014",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237003105",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237003101",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289002006",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289002060",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348055030",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081730",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021656",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289002021",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039960",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919001660",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289002015",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035520",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289002056",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789022582",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348055021",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289002028",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001705",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035530",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687078701",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919066621",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919001620",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025430",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919099430",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289002030",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267002304",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919099420",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919001630",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039910",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039920",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629421701",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135082505",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289002040",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267002309",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629426501",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039921",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629421601",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039940",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001701",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135082560",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289002063",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788897203",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788714102",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629758401",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788714103",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267076404",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820902",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039914",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687078711",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788897204",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820903",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005421",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788714104",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518219007",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518219000",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039930",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919066610",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518219001",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205050721",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005440",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851904",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518329400",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007510",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629421801",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267002308",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518219004",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007520",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081721",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788897202",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003320",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420019221",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788637403",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820904",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420050850",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420054550",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025460",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518219003",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003392",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425026901",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851903",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851902",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005492",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518219006",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518219002",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003330",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205050714",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518323401",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518219005",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205050730",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72508020505",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003394",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518323400",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081720",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007530",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205050740",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003393",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72508020501",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007882",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025421",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005430",
      "ndc_label_name": "Amoxicillin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81964020505",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205050720",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007801",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81964020501",
      "ndc_label_name": "Amoxicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781603955",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090040400",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988880",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988815",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135077642",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781603946",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988801",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781603958",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999019180",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090300500",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999019100",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788994901",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187020015",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090679100",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959018180",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090040600",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090605600",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205026615",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002021493",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959018108",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070601",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959018100",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135077668",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135077638",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959018101",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070655",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788830401",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205026680",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788901901",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070680",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007050",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959084301",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988675",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416076",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416078",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988601",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988650",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416073",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788885201",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788832401",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090426000",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615652",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615657",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615646",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919039932",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003201",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003250",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007001",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919067232",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007075",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003275",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788732301",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788861101",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093415573",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093415579",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999016800",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988915",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988980",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093415580",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999016880",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090634900",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070755",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988901",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090180700",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781604158",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090041100",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635100",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090646900",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070701",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267099315",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781604146",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788875901",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090040700",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002020993",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919071633",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002020991",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071152608",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788994801",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781604155",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788901701",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187088015",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919001533",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135077742",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135077738",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420057315",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135077768",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090040500",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187018615",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420057310",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267099400",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862070780",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804013415",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420057380",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090225100",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090631900",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090646600",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615757",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416176",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988775",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988750",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090134700",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090632300",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788873101",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416173",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635500",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615752",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189028532",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919040132",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007175",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090668000",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189038532",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093416178",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187026200",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090108600",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020750",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187026250",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788832501",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003301",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007150",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143988701",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788901801",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959029605",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205042200",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788731801",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205043600",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919063375",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020751",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781615746",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788873001",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090085800",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020752",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003350",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003375",
      "ndc_label_name": "Amoxicillin Suspension Reconstituted 400 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862007101",
      "ndc_label_name": "Amoxicillin SUSPENSION RECONSTITUTED 400 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518322800",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934014730",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079895",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090070900",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001401",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781506020",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093226301",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237002801",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090182500",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079825",
      "ndc_label_name": "Amoxicillin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001405",
      "ndc_label_name": "Amoxicillin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090159601",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090586301",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143928501",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090071301",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090071100",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710220",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093226401",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781506101",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090586300",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036620",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143928520",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003891",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090071302",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710230",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781506120",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063088520",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959066120",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629423701",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004120",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189046320",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090586302",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090071300",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090159500",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090071102",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002001320",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406202",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187032514",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420000320",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090588000",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090071400",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090159502",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090071200",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518219103",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835202",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001501",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090071401",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436454301",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090159501",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436002901",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090588001",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959066130",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518141301",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518219101",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237002901",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001320",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090159600",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237002920",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267130902",
      "ndc_label_name": "Amoxicillin TABLET 875 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187032520",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518219102",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003894",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518219104",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518219100",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687080918",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687080928",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003814",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205003520",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789022401",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205003514",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006414",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013520",
      "ndc_label_name": "Amoxicillin TABLET 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006491",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420013820",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006494",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038814",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804020020",
      "ndc_label_name": "Amoxicillin Tablet 875 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093226701",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090045400",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090045405",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063034104",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093226801",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710514",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710504",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999003300",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710503",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090045401",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959024640",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959024621",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710509",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919042430",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289018214",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090045500",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289018220",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289018230",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289018240",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289018290",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710530",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934014040",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959024619",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289018206",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959024630",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629426301",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289018209",
      "ndc_label_name": "Amoxicillin TABLET CHEWABLE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934014030",
      "ndc_label_name": "Amoxicillin Tablet Chewable 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862053350",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781610246",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093227773",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919039332",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781610252",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053375",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998175",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029202",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998150",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788830601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029203",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685101101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 200-28.5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781610257",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999035600",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788899601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016347",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788800001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090083200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452033443",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090622200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090593200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685101100",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781610452",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998250",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029302",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090587300",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781610457",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304700",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093227973",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998275",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090092800",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029303",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053450",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090083100",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090330900",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143998201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781610446",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090638100",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187082600",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788831801",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685101200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452033543",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090669400",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571016447",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685101201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043000901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712801",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043000903",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205046250",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919039132",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205046200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053475",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 400-57 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043000902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66685101202",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788830501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985324",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788815707",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093867574",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985316",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029403",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781613957",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985375",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093867575",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781613954",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788829901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781613948",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029402",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187085712",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053575",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714029401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093867578",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090185700",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205003612",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090099600",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090329300",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205003675",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788877007",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919069334",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187085775",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020351",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090221900",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712707",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862053513",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020354",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020354",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187085720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788997001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788815701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788877001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788829907",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788997007",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate SUSPENSION RECONSTITUTED 600-42.9 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043000803",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72508020369",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804001712",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043000802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020369",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205062075",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043000801",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81964020351",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687078111",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 250-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714047601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 250-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335289601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 250-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781187431",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 250-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162243503",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 250-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571016030",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 250-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862050130",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 250-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687078194",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 250-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714029501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 250-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420050330",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 250-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710703",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710704",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714029601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082002",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093227434",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781183120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571016101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781183101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571016142",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714047701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070215",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710730",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598020614",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254700",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254703",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070212",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090460402",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289084521",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714049401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070240",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070204",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289084530",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090699700",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071154502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082000",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070230",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090460400",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070214",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002023920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518218905",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082003",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289084528",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070221",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629423901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079211",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187003206",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289084520",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518262501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090460401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862050220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919001920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071006330",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187003221",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205001406",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090460403",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518262503",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135046220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005314",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267100101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788830802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205001420",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070209",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335282401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071006306",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005394",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66685100202",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005794",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518218904",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189063814",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289084506",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420050720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452033611",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335299901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789053321",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518262502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162243302",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518218902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789053330",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005714",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518262500",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205001421",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934012630",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162243301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335273501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162221002",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789041814",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093227534",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710830",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710804",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143924920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710820",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714001401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714001402",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781185220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571016201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082103",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440710803",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634080771",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714029701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714047802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714047801",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090632400",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082102",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317900",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781185201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082100",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063007703",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063007706",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571016242",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090652900",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090632401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714029702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082105",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090341400",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063037702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090632403",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070760",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090632402",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070710",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063007704",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082200",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090652903",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598022114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090700300",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289076721",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289076728",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082203",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289076730",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082202",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289076710",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687080311",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070730",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001414",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317903",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002014",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090231405",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289076720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020210",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289076714",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187042314",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090741500",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317905",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043020",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090652901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687080301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001420",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267085903",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070714",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090441300",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267071221",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090652902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919066520",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187042328",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187032720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518226304",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002078920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090441301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267100201",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002020",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187048820",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222504",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187042310",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518226305",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436100101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043014",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267071203",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222507",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187042320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205033120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919066514",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436312901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222508",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135046320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267071210",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205071914",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66685100101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007601",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629454101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070715",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518232500",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862050320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267085904",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72508022114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883602",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014714",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66685100100",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518232501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795802",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071154602",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008328",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222505",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014728",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828302",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187048814",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934016291",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452033711",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071422402",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014710",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518226303",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018003",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788931902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862050301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222503",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027901",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518226308",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81964022101",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222501",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267071230",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate TABLET 875-125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518226302",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222506",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81964022114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003914",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518232502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518226300",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071496702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789045914",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003991",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335291701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804017720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934011094",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008304",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518226301",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780502",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420050120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014704",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008314",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827102",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789045614",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014730",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003994",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788830702",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420000520",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018002",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014703",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222500",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934008620",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027902",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014720",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518232503",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205033114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003910",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789042114",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934011091",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205071220",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008303",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425021701",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008306",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205071920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018001",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162221102",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804017714",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162243401",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025320",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420052920",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027903",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804006020",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804020120",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093227034",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet Chewable 200-28.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093227234",
      "ndc_label_name": "Amoxicillin-Pot Clavulanate Tablet Chewable 400-57 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079137",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781233501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115148701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858061001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228305911",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407054901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049825",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975027810",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551137",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033210",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573046502",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059502",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664033788",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049895",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010003001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205603",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162137801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205606",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205609",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551237",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228306311",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115148801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573046602",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781234301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858021501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033310",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059602",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079237",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197401",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010003101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975027910",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205703",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205706",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664033888",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205709",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551337",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228306011",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895401",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115148901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781235201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573046702",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033410",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975028010",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050925",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079337",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205806",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059702",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664033988",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407056001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010003201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050995",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205809",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162137901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205803",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115149001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573046802",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079437",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407056101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228306411",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858032501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664034088",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033510",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051401",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781236801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551437",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975028110",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059802",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010003301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205906",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205903",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205909",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162138001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228306111",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084401",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664034188",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079537",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551537",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115149101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781237101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858093001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052025",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010003401",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722019501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059902",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975028210",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162138101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573046902",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206006",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033610",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407056201",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055301",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052095",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206003",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206009",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115148601",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527079037",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527551037",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205506",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993059402",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664033688",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895101",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228306211",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781232901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975033110",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629197801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573046402",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850051001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205509",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205503",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858005501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884083901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43975027710",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205501",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010002901",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407054801",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162137701",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629211001",
      "ndc_label_name": "Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097202",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076237",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185084201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781017601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150237",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064308",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687064495",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205003",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205006",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687064425",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462064901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629238001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205009",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516001401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064408",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076337",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150337",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555077602",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162123601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205106",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205103",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205109",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555077702",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076437",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150437",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406888501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781017801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064508",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462065101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205203",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205206",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516001301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205209",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097302",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185085301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162225101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205303",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722016301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781017901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462065201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629238201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205306",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076537",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064608",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150537",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205309",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629373101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516001201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185086401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076637",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107007401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185209901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150637",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722016401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629238101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781018001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097402",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205409",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064708",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462065301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205403",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516001101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162205406",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185209801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714094801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064108",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555097102",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406889101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806033901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150037",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204806",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781017401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107006801",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076037",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204803",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462064701",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095001",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204809",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629373201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516001601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406888401",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555077502",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534019101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527076137",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204909",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343016101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080301",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714094901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162123501",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064208",
      "ndc_label_name": "Amphetamine-Dextroamphetamine TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527150137",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204903",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850050101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204901",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015601",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204906",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858072201",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382095101",
      "ndc_label_name": "Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651055105",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959038928",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781214501",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959038920",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959038930",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781214505",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959038940",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440711640",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629426601",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651055101",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267002530",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267002528",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518260700",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267002540",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005928",
      "ndc_label_name": "Ampicillin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093753656",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291008530",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904619546",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729003515",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382020910",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063038315",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090500201",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268007515",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155085709",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090500200",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571042103",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090581200",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291001690",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090245301",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651023690",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991062033",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291008590",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991062010",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729003510",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991062090",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629526905",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090581201",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518242001",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001015504",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000890",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651023630",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729003516",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135049030",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155085703",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429028630",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155085705",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382020906",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291001630",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687011211",
      "ndc_label_name": "Anastrozole TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063038306",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629526901",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090245300",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000815",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268007511",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518242000",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135049090",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687011221",
      "ndc_label_name": "Anastrozole TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008020",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248401",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001015508",
      "ndc_label_name": "Anastrozole TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804016290",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189041530",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789034215",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008018",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008090",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117000301",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248400",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804016230",
      "ndc_label_name": "Anastrozole Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11917015590",
      "ndc_label_name": "Antacid & Antigas SUSPENSION 200-200-20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68788822803",
      "ndc_label_name": "Antacid Anti-Gas Max Strength Suspension 400-400-40 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917020015",
      "ndc_label_name": "Antacid Anti-Gas Max Strength Suspension 400-400-40 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00363113212",
      "ndc_label_name": "Antacid Anti-Gas Max Strength SUSPENSION 400-400-40 MG/5ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113058840",
      "ndc_label_name": "Antacid Anti-Gas Max Strength Suspension 400-400-40 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "75450029499",
      "ndc_label_name": "Antacid Anti-Gas Max Strength SUSPENSION 400-400-40 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000023401",
      "ndc_label_name": "Antacid Extra Strength Tablet Chewable 160-105 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015683",
      "ndc_label_name": "Antacid Extra Strength Tablet Chewable 675-135 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00363210316",
      "ndc_label_name": "Antacid Maximum TABLET CHEWABLE 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007653",
      "ndc_label_name": "Antacid Maximum TABLET CHEWABLE 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536199553",
      "ndc_label_name": "Anti-Dandruff SHAMPOO 1 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113054164",
      "ndc_label_name": "Anti-Itch Maximum Strength CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113097364",
      "ndc_label_name": "Anti-Itch Maximum Strength Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917004542",
      "ndc_label_name": "Anti-Nausea SOLUTION 1.87-1.87-21.5 ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536130297",
      "ndc_label_name": "Anti-Nausea Solution 1.87-1.87-21.5 Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777023101",
      "ndc_label_name": "Antifungal (Clotrimazole) Cream 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67777023102",
      "ndc_label_name": "Antifungal (Clotrimazole) Cream 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67777023110",
      "ndc_label_name": "Antifungal (Clotrimazole) Cream 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001047545",
      "ndc_label_name": "Antifungal (Clotrimazole) Cream 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67777023111",
      "ndc_label_name": "Antifungal (Clotrimazole) Cream 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67777023112",
      "ndc_label_name": "Antifungal (Clotrimazole) Cream 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67777023113",
      "ndc_label_name": "Antifungal (Clotrimazole) Cream 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001047547",
      "ndc_label_name": "Antifungal (Clotrimazole) Cream 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090016000",
      "ndc_label_name": "Antifungal (Tolnaftate) Cream 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904072236",
      "ndc_label_name": "Antifungal (Tolnaftate) Cream 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67777031601",
      "ndc_label_name": "Antifungal Powder 2 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135072085",
      "ndc_label_name": "Antifungal Powder 2 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000067901",
      "ndc_label_name": "Antifungal Powder 2 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000032301",
      "ndc_label_name": "Antifungal POWDER 2 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16784012363",
      "ndc_label_name": "Antifungal Powder 2 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67777031602",
      "ndc_label_name": "Antifungal Powder 2 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00713050306",
      "ndc_label_name": "Anucort-HC Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713050324",
      "ndc_label_name": "Anucort-HC Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713050301",
      "ndc_label_name": "Anucort-HC Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999071712",
      "ndc_label_name": "Anucort-HC Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713050312",
      "ndc_label_name": "Anucort-HC Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904016012",
      "ndc_label_name": "Anumed-HC SUPPOSITORY 25 MG",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65649041124",
      "ndc_label_name": "Anusol-HC Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65649041112",
      "ndc_label_name": "Anusol-HC Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00597000302",
      "ndc_label_name": "Aptivus CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00597000201",
      "ndc_label_name": "Aptivus Solution 100 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59809000504",
      "ndc_label_name": "Aquastat SFR Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59809000500",
      "ndc_label_name": "Aquastat SFR Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59809000502",
      "ndc_label_name": "Aquastat Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59809000501",
      "ndc_label_name": "Aquastat Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59809000503",
      "ndc_label_name": "Aquastat Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000501",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 100 MCG/ML INJECTION",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000504",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 100 MCG/ML INJECTION",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000201",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 25 MCG/ML INJECTION",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000204",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 25 MCG/ML INJECTION",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000404",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 60 MCG/ML INJECTION",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513000401",
      "ndc_label_name": "Aranesp (Albumin Free) SOLUTION 60 MCG/ML INJECTION",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002504",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 100 MCG/0.5ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002501",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 100 MCG/0.5ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002801",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 200 MCG/0.4ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513005701",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 25 MCG/0.42ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513005704",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 25 MCG/0.42ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513011101",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 300 MCG/0.6ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002101",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 40 MCG/0.4ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002104",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 40 MCG/0.4ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513003201",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 500 MCG/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002301",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 60 MCG/0.3ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513002304",
      "ndc_label_name": "Aranesp (Albumin Free) Solution Prefilled Syringe 60 MCG/0.3ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160084811",
      "ndc_label_name": "Arexvy Suspension Reconstituted 120 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54838057059",
      "ndc_label_name": "ARIPiprazole SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135090451",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651011055",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722068415",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603044501",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162089374",
      "ndc_label_name": "ARIPiprazole SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010020",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70752011407",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689073505",
      "ndc_label_name": "ARIPiprazole Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505040405",
      "ndc_label_name": "ARIPiprazole SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904736861",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714014301",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651106",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078501",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021805",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028001",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021890",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904736806",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021830",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722082730",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651161",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014705",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014745",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055630",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014715",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028010",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090307300",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429044830",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005303",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030403",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598096730",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009971",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547088650",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005308",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009931",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267403",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547088603",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090493601",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008915",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043205",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090640901",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300017713",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089803",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267408",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008911",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687017901",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687017965",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282000",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739007410",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012407",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780806",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687017911",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043203",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009930",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282001",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335190301",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043201",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48433011710",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780809",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089809",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780803",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066330",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335190302",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804023690",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518276500",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629700301",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282002",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518142102",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018230",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780801",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335190303",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066305",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162236905",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518142101",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015505",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780802",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018205",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518258000",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282004630",
      "ndc_label_name": "ARIPiprazole TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518142103",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335190304",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189047630",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015530",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009009005",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804002330",
      "ndc_label_name": "ARIPiprazole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021990",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021930",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028101",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651204",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030503",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012507",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021905",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078601",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090282400",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714014401",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028110",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904736904",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598096830",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055730",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005403",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547088703",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429044930",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518256700",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005408",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687019194",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48433011810",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687019111",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722082830",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009011",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267508",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518286900",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300017813",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089903",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090269100",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010071",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629710801",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066405",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687019121",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788700606",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547088750",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089909",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010030",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015630",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788700601",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043305",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043303",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282004730",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009012",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066430",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518256701",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043301",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518250801",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518286902",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788700602",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267503",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518264300",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518286901",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788700603",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010031",
      "ndc_label_name": "ARIPiprazole TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018330",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018305",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788700609",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739007833",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009009105",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518250800",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015605",
      "ndc_label_name": "ARIPiprazole Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012207",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078301",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090748501",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027810",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904736604",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904650904",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030203",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722081930",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009730",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027801",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008711",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005108",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021605",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021630",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547088403",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547088450",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707606",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48433011510",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009731",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090748500",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021690",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714014101",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598096530",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090710500",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773301",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090756400",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629701701",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687015721",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005103",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300017513",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090756401",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008712",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518338001",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505307508",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707603",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089609",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687015711",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055430",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518273600",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687015794",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009771",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089603",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707609",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066105",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739006933",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429044630",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518338000",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066130",
      "ndc_label_name": "ARIPiprazole TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518309000",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043003",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773302",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043001",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015330",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505307503",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335168201",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043005",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518258401",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707602",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205048030",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773303",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189046630",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707601",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518295800",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773306",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773309",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518258400",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335198001",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018005",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015305",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335189201",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009008805",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018030",
      "ndc_label_name": "ARIPiprazole Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022005",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028201",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904737004",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714014501",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043403",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518251401",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547088850",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651304",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300017913",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005508",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022030",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005503",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706309",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518280602",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090640300",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022090",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722082930",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012607",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547088803",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014009",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518255700",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015705",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687020211",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078701",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014005",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014015",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010130",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014045",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518301101",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282004830",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043401",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028210",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055830",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48433011910",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010171",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030603",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335168701",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090712500",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706303",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090486300",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009111",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687020294",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043405",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598096930",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018430",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162090103",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706301",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606300",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429045030",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162090109",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518251400",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009112",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267603",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066530",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518301100",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518280600",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267608",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706302",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706306",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687020221",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518300400",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015730",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518300401",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760069130",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189045530",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010131",
      "ndc_label_name": "ARIPiprazole TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066505",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518251402",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518280601",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018405",
      "ndc_label_name": "ARIPiprazole Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714014601",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055930",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48433012010",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078801",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022105",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904737104",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030703",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651404",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162090209",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043505",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009211",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300018013",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722083030",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010271",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547088903",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022130",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518256500",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518297401",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429045130",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547088950",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012707",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668022190",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010231",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009212",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282700",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028301",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021394",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066630",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598097030",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028310",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066605",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043501",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518297400",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005603",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282701",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518256501",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267703",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005608",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043503",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014805",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267708",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014815",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018505",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014845",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010230",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021311",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518130300",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021321",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015830",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162090203",
      "ndc_label_name": "ARIPiprazole TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015805",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018530",
      "ndc_label_name": "ARIPiprazole Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547088503",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018015",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021730",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651006",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714014201",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722082030",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021705",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651061",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716202",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090466500",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027901",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904665640",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005208",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012307",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090583901",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904736706",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282500",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584000",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090307000",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904736761",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687016865",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547088550",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267303",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714078401",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518292100",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739041310",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739007010",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668021790",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009830",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598096630",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716206",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027910",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183203",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066230",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808901",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547030303",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009871",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090416000",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774903",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241005203",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183204",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043105",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518097000",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598055530",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089709",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090583900",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774906",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300017613",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189045630",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808902",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518292102",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090466501",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862066205",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090656300",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518126300",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018079",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043103",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518253600",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205039230",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090656301",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335151301",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008811",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518251501",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48433011610",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018130",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518292101",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183206",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716209",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282502",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687016801",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335189304",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268008815",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046214",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183202",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015405",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774901",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804023590",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687016811",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429044730",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015430",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808903",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009831",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267308",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009008905",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808906",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043101",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162089703",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716201",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808909",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716203",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518282501",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774902",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018105",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774909",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518295000",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518126301",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183205",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518251500",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518289700",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183201",
      "ndc_label_name": "ARIPiprazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282004530",
      "ndc_label_name": "ARIPiprazole TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598073330",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578010678",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010330",
      "ndc_label_name": "ARIPiprazole TABLET DISPERSIBLE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043040003",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578010606",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452033813",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043040103",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332010430",
      "ndc_label_name": "ARIPiprazole TABLET DISPERSIBLE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598073430",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578010706",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578010778",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452033913",
      "ndc_label_name": "ARIPiprazole Tablet Dispersible 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757050003",
      "ndc_label_name": "Aristada Initio Prefilled Syringe 675 MG/2.4ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040401",
      "ndc_label_name": "Aristada Prefilled Syringe 1064 MG/3.9ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040403",
      "ndc_label_name": "Aristada Prefilled Syringe 1064 MG/3.9ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040101",
      "ndc_label_name": "Aristada Prefilled Syringe 441 MG/1.6ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040103",
      "ndc_label_name": "Aristada Prefilled Syringe 441 MG/1.6ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040201",
      "ndc_label_name": "Aristada Prefilled Syringe 662 MG/2.4ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040203",
      "ndc_label_name": "Aristada Prefilled Syringe 662 MG/2.4ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040303",
      "ndc_label_name": "Aristada Prefilled Syringe 882 MG/3.2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65757040301",
      "ndc_label_name": "Aristada Prefilled Syringe 882 MG/3.2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862080630",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788003",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781803731",
      "ndc_label_name": "Armodafinil TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309256",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017803",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378343293",
      "ndc_label_name": "Armodafinil TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004190",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788009",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789012690",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788006",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919077030",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068101",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004130",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004160",
      "ndc_label_name": "Armodafinil Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782606",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017903",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782609",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781804531",
      "ndc_label_name": "Armodafinil TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309356",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035330",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651004730",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862099830",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782603",
      "ndc_label_name": "Armodafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789006090",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700051030",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759306",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378343393",
      "ndc_label_name": "Armodafinil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309456",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759309",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184201",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781805331",
      "ndc_label_name": "Armodafinil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759303",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026130",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335130801",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862080730",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339018003",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189013330",
      "ndc_label_name": "Armodafinil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378343193",
      "ndc_label_name": "Armodafinil TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862080530",
      "ndc_label_name": "Armodafinil Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017703",
      "ndc_label_name": "Armodafinil Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189046430",
      "ndc_label_name": "Armodafinil Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093309056",
      "ndc_label_name": "Armodafinil Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781802931",
      "ndc_label_name": "Armodafinil TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999028228",
      "ndc_label_name": "Armour Thyroid Tablet 180 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999028260",
      "ndc_label_name": "Armour Thyroid Tablet 180 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00456046201",
      "ndc_label_name": "Armour Thyroid TABLET 180 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00456046301",
      "ndc_label_name": "Armour Thyroid TABLET 240 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00456046401",
      "ndc_label_name": "Armour Thyroid TABLET 300 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536111825",
      "ndc_label_name": "Arthritis Pain Relieving Cream 0.075 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917014378",
      "ndc_label_name": "Artificial Tears PF Solution 0.1-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917010504",
      "ndc_label_name": "Artificial Tears PF Solution 0.1-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917010220",
      "ndc_label_name": "Artificial Tears PF Solution 0.1-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917017746",
      "ndc_label_name": "Artificial Tears PF Solution 0.1-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917003688",
      "ndc_label_name": "Artificial Tears Solution 0.1-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917006269",
      "ndc_label_name": "Artificial Tears Solution 0.1-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011678",
      "ndc_label_name": "Artificial Tears Solution 0.1-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011701",
      "ndc_label_name": "Artificial Tears Solution 0.1-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917004108",
      "ndc_label_name": "Artificial Tears Solution 0.1-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000001101",
      "ndc_label_name": "Artificial Tears Solution 0.5-0.6 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66267092315",
      "ndc_label_name": "Artificial Tears Solution 1.4 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17478006012",
      "ndc_label_name": "Artificial Tears Solution 1.4 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090228300",
      "ndc_label_name": "Artificial Tears Solution 1.4 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959004100",
      "ndc_label_name": "Artificial Tears Solution 1.4 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135014203",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135014201",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917004628",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00761009450",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917014055",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917004627",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440712060",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16103035511",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135014205",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135014210",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917004629",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135014269",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135014260",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007522",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536329210",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629045003",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768045058",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013938",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007521",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16103035599",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49614050678",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768000517",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00761009420",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487002501",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487002502",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16103035508",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864092099",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629008602",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135016513",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768002517",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292022325",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487002503",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604001486",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49999035200",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292022326",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629009210",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604001881",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768019570",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295012840",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312001513",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864000059",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629007601",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864000060",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295012841",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604001485",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312001515",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61919060471",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94604021220",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40093010604",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312001510",
      "ndc_label_name": "Ascorbic Acid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312001474",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295012842",
      "ndc_label_name": "Ascorbic Acid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59762288806",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762288801",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991036060",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991036017",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332019960",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794001710",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332019931",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 10 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794001610",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991035860",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762201206",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762201201",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332019831",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332019860",
      "ndc_label_name": "Asenapine Maleate Tablet Sublingual 5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205051730",
      "ndc_label_name": "Aspirin Buf(CaCarb-MgCarb-MgO) Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71205051760",
      "ndc_label_name": "Aspirin Buf(CaCarb-MgCarb-MgO) Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904679489",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142027468",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904679430",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363021879",
      "ndc_label_name": "Aspirin Low Dose TABLET CHEWABLE 81 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904750930",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090702800",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904679480",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917009500",
      "ndc_label_name": "Aspirin Low Dose TABLET CHEWABLE 81 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54738012890",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518242203",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142046768",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483033463",
      "ndc_label_name": "Aspirin Low Dose TABLET CHEWABLE 81 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800046768",
      "ndc_label_name": "Aspirin Low Dose TABLET CHEWABLE 81 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518242204",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800027468",
      "ndc_label_name": "Aspirin Low Dose TABLET CHEWABLE 81 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54738012836",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090702900",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518242205",
      "ndc_label_name": "Aspirin Low Dose Tablet Chewable 81 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00574703412",
      "ndc_label_name": "Aspirin SUPPOSITORY 300 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00574703612",
      "ndc_label_name": "Aspirin Suppository 600 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135015001",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363015798",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363015716",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363015714",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49614041678",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135015010",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135015024",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135015005",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135015030",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536105405",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536105429",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135015069",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090000208",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135015020",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16103036511",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16103036599",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16103036508",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090161704",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142041678",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917004161",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090161708",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250011811",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864000016",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142041687",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959072414",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959072430",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896090101",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917011652",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000025304",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090000204",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959072400",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864000017",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959072424",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267002730",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60760085424",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800015712",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518105900",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49614041687",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959072410",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999081300",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896090110",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959072415",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788825602",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999081330",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189018760",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54738054101",
      "ndc_label_name": "Aspirin TABLET 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54348098630",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090619508",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000025302",
      "ndc_label_name": "Aspirin TABLET 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60760004724",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54738054102",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60760016124",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "82804016760",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60760093024",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518306900",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66553000101",
      "ndc_label_name": "Aspirin TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788825601",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518105901",
      "ndc_label_name": "Aspirin Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440713040",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440713016",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440713018",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363022757",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440713090",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904678480",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440713030",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904671260",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012613",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43063092650",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440713060",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440713020",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012610",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012675",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16103035799",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012603",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012630",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292055611",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536114801",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536123201",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917019317",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16103035711",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483033110",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012669",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012650",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090446205",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904201380",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012620",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33261015314",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090000401",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090000403",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917017758",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33358003600",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000003501",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012601",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012627",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959001814",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090000405",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959001860",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33261015300",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49614011378",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335015707",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012660",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917005691",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54738011103",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959001880",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54738011101",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33261015330",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090345001",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335056803",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135012690",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800037012",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55700033830",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896092101",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896092201",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33261015360",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959001824",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896092110",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16103035708",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292055595",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896092120",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000001401",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63739052301",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292055612",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959001830",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335015703",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33261015390",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483033101",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205031860",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335015704",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000035901",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090446201",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60760079924",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335051304",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33358003630",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959001820",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335015702",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335051306",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71610003465",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959001840",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504010105",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267002660",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483003210",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504007495",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335056801",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69618001510",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80425029302",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205031820",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788067801",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80425029301",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090446203",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335015701",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335056807",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335015706",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959001800",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335051303",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205031830",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335056802",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896092125",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335056805",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71800004101",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60760092124",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504010405",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267002630",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67544046830",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69618001501",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335015705",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335051301",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335051302",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335051305",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335051307",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335056804",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335056806",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80425029303",
      "ndc_label_name": "Aspirin Tablet Delayed Release 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135017305",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363041474",
      "ndc_label_name": "Aspirin TABLET DELAYED RELEASE 81 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363058732",
      "ndc_label_name": "Aspirin TABLET DELAYED RELEASE 81 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135017369",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363058714",
      "ndc_label_name": "Aspirin TABLET DELAYED RELEASE 81 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363043982",
      "ndc_label_name": "Aspirin TABLET DELAYED RELEASE 81 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440713590",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440713585",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135068962",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363043925",
      "ndc_label_name": "Aspirin TABLET DELAYED RELEASE 81 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800003018",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33261015230",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440713581",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440713591",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135017301",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135072910",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33261015290",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135017336",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483007010",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33261015260",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16103035611",
      "ndc_label_name": "Aspirin TABLET DELAYED RELEASE 81 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33261015200",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135017310",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135072962",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090055203",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135017362",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289088698",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33358003501",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483007012",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483010710",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33358003530",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16103035609",
      "ndc_label_name": "Aspirin TABLET DELAYED RELEASE 81 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959077030",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43063086290",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71406012812",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864000018",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483010701",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51824007701",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090055201",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090055202",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289088601",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629897901",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162147003",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335019501",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090283200",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335062201",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51824005501",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54257027425",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289088635",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335019502",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189018860",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335062204",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289088690",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335062202",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54257027406",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335177407",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629282503",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335019503",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "76420022490",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789003935",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629282501",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335177403",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629282502",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "76420022430",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504002896",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335019505",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629889301",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "77333003120",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629889401",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189018830",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267002830",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "77333003125",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335062203",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335177405",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335062207",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789003901",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63739052201",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335177406",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335177401",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335177408",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335062205",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335177402",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63739052210",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335177404",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335062206",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71800004002",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335019504",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789003998",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335019506",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "76420022460",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335019507",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71406012810",
      "ndc_label_name": "Aspirin Tablet Delayed Release 81 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904705699",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598033960",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291011660",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714096401",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884000702",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407027160",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571027460",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175033035",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162059606",
      "ndc_label_name": "Aspirin-Dipyridamole ER CAPSULE EXTENDED RELEASE 12 HOUR 25-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559085060",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462040560",
      "ndc_label_name": "Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722065360",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238113606",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862071160",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093552606",
      "ndc_label_name": "Atazanavir Sulfate CAPSULE 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385092060",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714086001",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097044403",
      "ndc_label_name": "Atazanavir Sulfate Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440717290",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378075710",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090044803",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093075305",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573803",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093075301",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440717230",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041205",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090044800",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041201",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090044805",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353088760",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429002610",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378075701",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629262603",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079068520",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090341000",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090341003",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090341005",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526600",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429002690",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041210",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980043901",
      "ndc_label_name": "Atenolol TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959025830",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573800",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526603",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079068501",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919085430",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760064290",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098660",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382002410",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002113803",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090631103",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862017001",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959025860",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304062310",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919085490",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573805",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162232600",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267002991",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629262604",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090631100",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002113800",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518293901",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629262601",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090631105",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304062301",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002113806",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980043910",
      "ndc_label_name": "Atenolol TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629262602",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518088200",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267002992",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518293902",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834028300",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518293900",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862017099",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382002401",
      "ndc_label_name": "Atenolol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518088202",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162232609",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189015290",
      "ndc_label_name": "Atenolol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063095230",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904718761",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093078701",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083330",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440717045",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378021810",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378021801",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093078710",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063095290",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063080590",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041005",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090341105",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571043011",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090341100",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440717090",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440717030",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090624100",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083345",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041010",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079075901",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999045410",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700075530",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083380",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041001",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187053710",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999045490",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063080501",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959046330",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090051404",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060501",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090051400",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063080530",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980043710",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090051402",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083360",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429002790",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090051405",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060511",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090051406",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999045400",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544024030",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090341104",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090341102",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304062110",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959046301",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760043730",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090760300",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999045460",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787603",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090540805",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090540802",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544024060",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429002710",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304062101",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919027960",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090624102",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873903",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090693500",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079075920",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787609",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760025690",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544024092",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919091471",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090624105",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934017730",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002110803",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959046360",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873906",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760043790",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382002210",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629178503",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760016390",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065860",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002110806",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002110800",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518300700",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760078790",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518039902",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544024045",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629178501",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065880",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919027930",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919027990",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518300701",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980043701",
      "ndc_label_name": "Atenolol TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085745",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544024080",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852703",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162232409",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629178502",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778401",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065830",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862016899",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085753",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873909",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852706",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382002201",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862016801",
      "ndc_label_name": "Atenolol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787601",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065892",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778409",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778403",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205009690",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852709",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787606",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778406",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518039900",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085760",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852701",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873901",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162232400",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085730",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934017760",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189014630",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065845",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039690",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189014660",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039630",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085780",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189014690",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834028100",
      "ndc_label_name": "Atenolol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378023101",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378023110",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356073730",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041105",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440717110",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093075201",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093075210",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440717130",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440717160",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440717192",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353093960",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090536701",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083445",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440717145",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440717106",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571043111",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440717190",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353093930",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090044200",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090574101",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083473",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041101",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083060",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063076590",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083460",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090304301",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090304304",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090574104",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090044208",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041110",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090304308",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083073",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090044201",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002100403",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090536308",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959025340",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090304307",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063076530",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090536301",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083430",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090044204",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760016430",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959025300",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489052910",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090536300",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353093945",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090536307",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083480",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090304300",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760064390",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959025320",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934014230",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079068401",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353093973",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090536700",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090536707",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090523308",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919093590",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959025330",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086180",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700075430",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353093980",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090574100",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090677900",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090536708",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518303601",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002100406",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189013530",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760016490",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090044207",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429002590",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784700",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025730",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022990",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760064330",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014490",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980043801",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090281100",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760005990",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002100400",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187020130",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162232500",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980043810",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348014230",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518037902",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090536304",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025790",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429002510",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304062201",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014430",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382002310",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919066430",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005230",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090574107",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304062210",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862016901",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761603",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090574108",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645058554",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382002301",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883403",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079068420",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862016999",
      "ndc_label_name": "Atenolol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518037901",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518303600",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919093530",
      "ndc_label_name": "Atenolol TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883406",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518286600",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518303602",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761609",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761601",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934021930",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086130",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518035102",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518037900",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086160",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761606",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162232509",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022930",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883401",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205049630",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883409",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086145",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335095404",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834028200",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086173",
      "ndc_label_name": "Atenolol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710116801",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300040101",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289098830",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714093701",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591578301",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954039110",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135073401",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518244600",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300040001",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135073301",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710116701",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591578201",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 50-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014909",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289099330",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 50-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954039010",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714093601",
      "ndc_label_name": "Atenolol-Chlorthalidone Tablet 50-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289099360",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 50-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289099390",
      "ndc_label_name": "Atenolol-Chlorthalidone TABLET 50-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70000032101",
      "ndc_label_name": "Athletes Foot Powder Spray Aerosol Powder 2 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16714075501",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722071430",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573041530",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162254103",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111051930",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380047201",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354256",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010030",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291006430",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026530",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283003",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037303",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004030",
      "ndc_label_name": "Atomoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090746300",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354856",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573042130",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291007030",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714076101",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162254703",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010630",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090614400",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722072030",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283603",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462027130",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380047801",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111056430",
      "ndc_label_name": "Atomoxetine HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037903",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291006530",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722071530",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111052030",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075601",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354356",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037403",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380047301",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162254203",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573041630",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026630",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010130",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283103",
      "ndc_label_name": "Atomoxetine HCl Capsule 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075701",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005711",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354456",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005713",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090651200",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722071630",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090670300",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004230",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111052830",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291006630",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573041730",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010230",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283203",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687056711",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026730",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687056721",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090734200",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037503",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162254303",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380047401",
      "ndc_label_name": "Atomoxetine HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090423600",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722071730",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354556",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291006730",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075801",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335303301",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904690804",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090746200",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005813",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090614300",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026830",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037603",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573041830",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090628900",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162254403",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687032625",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111052130",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090651300",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010330",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687032695",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005811",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004330",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283303",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380047501",
      "ndc_label_name": "Atomoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090625400",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354656",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075901",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573041930",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010430",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090644400",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291006830",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005913",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283403",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090739700",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722071830",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993004430",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380047601",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268005911",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162254503",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026930",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111052230",
      "ndc_label_name": "Atomoxetine HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037703",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090612700",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354756",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573042030",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714076001",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722071930",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090651100",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291006930",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980037803",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380047701",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111056330",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162254603",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505283503",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462027030",
      "ndc_label_name": "Atomoxetine HCl CAPSULE 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010530",
      "ndc_label_name": "Atomoxetine HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395005",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395077",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712560",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781538192",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505610",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571013610",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017303",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571013609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629061",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505698",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004417",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712581",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571013650",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064910",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712585",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042410",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017302",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629006",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083005",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004415",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063047430",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094011",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050710",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353012060",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017210",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598009890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094005",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020820",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020801",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505257808",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760090390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353011545",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007810",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090549701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012105",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790009",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919095690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009315",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353011560",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012190",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154663500",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629846901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651060690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598009805",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700087730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772002",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840903",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063509",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505257809",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082705",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400809",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840906",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382024910",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763003",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761809",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865606",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009311",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382024916",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089046",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839506",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400803",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651060699",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788955603",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097089715",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739001810",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089043",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839509",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518194600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756024712",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760066630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838906",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009711",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868409",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710177700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867206",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189053190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919095630",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094415",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071091430",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884203",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756024751",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518329800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603028202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377007711",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645048054",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400806",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934048230",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934007030",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009000110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009701",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518194602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761803",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377002711",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205080230",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002299",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763006",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790006",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016960",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761806",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763009",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518194601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335238802",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603040301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790003",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838909",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162155409",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797903",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797906",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934048290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838903",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603028203",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797909",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205080290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603040302",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840909",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789015330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867203",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788859109",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097089705",
      "ndc_label_name": "Atorvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771045190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710177709",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377007713",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205024630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868406",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009017610",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518022402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884206",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603028201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377002713",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771045110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756024790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025550",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009000190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395177",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135065005",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712685",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505998",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505910",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781538292",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042505",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712660",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712681",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395105",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629161",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598009905",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629106",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571013709",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050810",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571013750",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090488001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571013710",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598009990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049630",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353090409",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004515",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353089245",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090738602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518200",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518102",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094111",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004517",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042510",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090752900",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090738600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648102",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353085109",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049660",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090660400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012290",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090738601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772300",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353089209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353090445",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651060790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505257908",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772200",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651060799",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353090460",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090738700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436998803",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739002010",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655092152",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090752800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020901",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629847001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025010",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154663400",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089143",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648200",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009411",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505257909",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787406",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090660402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090125701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079020920",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051210",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082805",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787409",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007905",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760088390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009801",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798606",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788968303",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861309",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700087130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090660401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063230",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009811",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518087800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861303",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868309",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645048154",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090752801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518197701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861306",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837003",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090752802",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025016",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868306",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518197702",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518284300",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377002813",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763103",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869303",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710177509",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862506",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518197700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009415",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763106",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934029630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377002811",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002245",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518263500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868303",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101003",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018015",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756024890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002260",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518332600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012205",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869309",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837009",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074415",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018045",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162171202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018030",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756024812",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089146",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094512",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162155509",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162171204",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162171203",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074445",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335240408",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629847101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518333900",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841606",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771045205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189058730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074453",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011645",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862509",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771045290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603040402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025650",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074470",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603028301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071091530",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097089812",
      "ndc_label_name": "Atorvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804016190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162171206",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009000210",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763109",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335240403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094505",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011660",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162171207",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162155505",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162171209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377007811",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189058790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837006",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603028303",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804005430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377007813",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869306",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009017710",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097089805",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518087803",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518018602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710177500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518303700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756024851",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518341400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002399",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205024730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603040401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018060",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804005490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074460",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804016130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189029190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603028302",
      "ndc_label_name": "Atorvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629261",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712760",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505898",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505810",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395277",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712781",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571013850",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712785",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395205",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781538492",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571013809",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629206",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135065110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571013810",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004615",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082645",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087345",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042605",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042610",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045330",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028045",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028745",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004617",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028760",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082160",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090633400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082115",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082615",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050910",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090633300",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090689100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094290",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598010190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094211",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082660",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598010105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090644000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090738401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090680002",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017410",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028715",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090591600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090644001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090680100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028015",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090592100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082145",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090633302",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090689001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090689000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087315",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090780601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095945",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090343800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090738400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651060899",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154664600",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095915",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458088116",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090738402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760070930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760088230",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090780600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083205",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090592101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090780602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008010",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090343801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505258009",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520702",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090644002",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009511",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788829803",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082905",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012390",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090633301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760073430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563200",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090680001",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436998901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304082990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505258008",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090591500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090738500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079021020",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377002913",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739003610",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760090530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090591501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015702",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377007911",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009901",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089241",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063709",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779906",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090644100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090780700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032505",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377007913",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063702",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089246",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779903",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857409",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090680000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079021001",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760055830",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518132201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025110",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009911",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809406",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710177200",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760090590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518132202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645056854",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025116",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809409",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756024951",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009515",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012305",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760097930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710177209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518132204",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335971103",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651060890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831506",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030330",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205076530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888709",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335972306",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335972305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888703",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187010990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335972302",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097089905",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016845",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888706",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016860",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756024912",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071091630",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016815",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094605",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074515",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097089915",
      "ndc_label_name": "Atorvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779909",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002499",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377002911",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074553",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756024990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788829801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335972303",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788829809",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603028401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934034230",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788829806",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603040502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025750",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205026490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771045310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335076701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771045390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831509",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009017810",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205076590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008008090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335132202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016315",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094615",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335076703",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162223809",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016345",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518327300",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335972304",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804002690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016830",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205073130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335972301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603028402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335972307",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074545",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603028403",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074560",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603040501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008930",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804005630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009000310",
      "ndc_label_name": "Atorvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505705",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135065305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712830",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629304",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017603",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395305",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781538892",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093505798",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712860",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087703",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042705",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378395377",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712885",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440712881",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658051010",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571013909",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004715",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042710",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571013910",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658051090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004716",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598010305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081545",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032160",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571013950",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094301",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090529800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017510",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081560",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714087702",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082753",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032115",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081515",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563900",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032145",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606100",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084315",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094311",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082760",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081579",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082715",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090605701",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084360",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606101",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084345",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098115",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082730",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606102",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735900",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090650600",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098345",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082745",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098315",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098145",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032605",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090753202",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598010390",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098160",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090605700",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154438406",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267108",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090753300",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735802",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090126500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090529801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090697000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651060990",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505267109",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651060999",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090753201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563901",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090605400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598083305",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053130",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051410",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090605401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735800",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090753200",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089741",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063802",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762015802",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079021103",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187090790",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187065690",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180063809",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304083005",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012490",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009612",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304083090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645049554",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772402",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059095",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377008011",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739003733",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175089746",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629847201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518151400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813209",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772500",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788899109",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710177000",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025210",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059025",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813201",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710177009",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788899106",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268009611",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097091105",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003615",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788899101",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025216",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813206",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205033590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518330400",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012405",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097091112",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009430",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377003014",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205009890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934051330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335058302",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756025051",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053190",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094712",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017030",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518151401",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335058301",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017060",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603028501",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377008013",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063345",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756025090",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003645",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017045",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074615",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335058303",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877051490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003660",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063360",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009445",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017015",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063330",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074645",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189053790",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813203",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074630",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074660",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771045405",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063315",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074653",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002599",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162155609",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788899103",
      "ndc_label_name": "Atorvastatin Calcium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002590",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025801",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603028502",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603040602",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603028503",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603040601",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009017910",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094705",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025850",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377003012",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834025890",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205033530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009415",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009460",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189029530",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002505",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771045490",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009000410",
      "ndc_label_name": "Atorvastatin Calcium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121089818",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121179610",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904706425",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121179620",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687053440",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121088842",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904745925",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089805",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121101605",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008611",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904706453",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904745953",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462042169",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089842",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011911",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121095608",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722062921",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135052824",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702022321",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687053436",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033010542",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121101642",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689006218",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121101618",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135052845",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748029901",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268011912",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687053478",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462042121",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739020303",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135052809",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714090001",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033010522",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603024801",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739020302",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462042105",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162069388",
      "ndc_label_name": "Atovaquone SUSPENSION 750 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73141010405",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689006242",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268008612",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033010442",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452025287",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407064287",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73141010442",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033010405",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033010422",
      "ndc_label_name": "Atovaquone Suspension 750 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065081702",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478021505",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505622600",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090731300",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090629500",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478021502",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00065081701",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090700000",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478021515",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219174802",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090310400",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76478001515",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219174903",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603026401",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219175008",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069058101",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505622602",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069058201",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069058301",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756065125",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505622601",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756065335",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756065225",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76478001505",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069071601",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603026402",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82260000101",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76478001502",
      "ndc_label_name": "Atropine Sulfate Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00597008717",
      "ndc_label_name": "Atrovent HFA Aerosol Solution 17 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090096100",
      "ndc_label_name": "Atrovent HFA Aerosol Solution 17 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59627033304",
      "ndc_label_name": "Avonex Pen Auto-injector Kit 30 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59627022205",
      "ndc_label_name": "Avonex Prefilled Prefilled Syringe Kit 30 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353074509",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571083501",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084022901",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291007101",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084022911",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219107601",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877049301",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378100501",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030660",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407018201",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382000301",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074560",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877049305",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462050201",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012409",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382000305",
      "ndc_label_name": "AzaTHIOprine TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789012930",
      "ndc_label_name": "azaTHIOprine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505057804",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.05 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335093890",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.05 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069009101",
      "ndc_label_name": "Azelastine HCl Solution 0.05 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478071810",
      "ndc_label_name": "Azelastine HCl Solution 0.05 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61314030802",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.05 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332050606",
      "ndc_label_name": "Azelastine HCl Solution 0.05 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72266014101",
      "ndc_label_name": "Azelastine HCl Solution 0.05 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335077991",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.1 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629205701",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991081403",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054029399",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090233000",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205044930",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162160103",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253800",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291009430",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405602",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090527100",
      "ndc_label_name": "Azelastine HCl Solution 0.1 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505083305",
      "ndc_label_name": "Azelastine HCl SOLUTION 0.1 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762305102",
      "ndc_label_name": "Azithromycin Packet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762305105",
      "ndc_label_name": "Azithromycin Packet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762305101",
      "ndc_label_name": "Azithromycin Packet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762311001",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090186800",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806014731",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093202723",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 100 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090249100",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788012813",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822901",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867501",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386047060",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651000715",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436022034",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710145701",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071152705",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 100 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135070451",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763601",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093202694",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093202623",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090622600",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090629600",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093202631",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788012914",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806015134",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806015033",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658070632",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788012915",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672420003",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672420005",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788012913",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806014932",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090183500",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098300",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658070733",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098400",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436022236",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762313001",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386047161",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651000830",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135070543",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090250900",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658070834",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135070552",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867603",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135070551",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090445800",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187009322",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762312001",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090626700",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700073130",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436022134",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071152805",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822203",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651000815",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205021630",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824601",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672420007",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651000823",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436022849",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205056615",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959093215",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762314001",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710146002",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788754903",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959093230",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710145802",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919038230",
      "ndc_label_name": "Azithromycin SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710145902",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788826003",
      "ndc_label_name": "Azithromycin Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090452700",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527237020",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440717506",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224002230",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527237032",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781808926",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781808931",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440717504",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472000",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571069503",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571069581",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762219807",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904670861",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472001",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904670806",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178801",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687028265",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571069516",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291008230",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687028211",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904735006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436078701",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321300",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090460100",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760050206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063072802",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687074211",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904735061",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700085906",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472102",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436435601",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094090006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069306",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090460101",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036206",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291008206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687028201",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111078710",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118078706",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180016006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090338501",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472103",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187060406",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063072804",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760080806",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111078766",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332025118",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180016011",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090460202",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090643600",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105067005",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069387",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919055506",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224002250",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000706",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788765406",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472101",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111078751",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677012906",
      "ndc_label_name": "Azithromycin TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090095800",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862064130",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224002260",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679096101",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268007415",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436149601",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518321700",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178800",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862064169",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762219803",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105067018",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518078401",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224002218",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224002206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205015806",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090338500",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094090030",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687074265",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094090018",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002222404",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700085206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205042706",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090755000",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518243301",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187016906",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788810106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205015866",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002222806",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000187",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268007413",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205043006",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105067001",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452017104",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000130",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700035106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000704",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017030",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436435701",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048304",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071039204",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205043004",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804021406",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762219801",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629267301",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420000606",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959083806",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425021801",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812406",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687074201",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679096105",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862064163",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008008106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332025130",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043101",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518243300",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189009306",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180016013",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105067003",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094090050",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004606",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452017173",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105067006",
      "ndc_label_name": "Azithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518243302",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021306",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518080300",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180086106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788706606",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180086111",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205042406",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518256201",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518243303",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518270800",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064506",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205011904",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008906",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008104",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518256202",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452017113",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000106",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518073600",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008102",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518256200",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008710",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425021901",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804018206",
      "ndc_label_name": "Azithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571069603",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904690904",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193900",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781809003",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071305",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071303",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527239519",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781809031",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090452801",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904735104",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090233500",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071302",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090233400",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090460600",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527239532",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291008303",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111078810",
      "ndc_label_name": "Azithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291008330",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090470000",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193901",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090413201",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090729900",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071307",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090096000",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224012250",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071379",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090536600",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090452800",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090537600",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105065303",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224012209",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090165500",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687075311",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090240700",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090536601",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111078867",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268007612",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105065306",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959092703",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090165501",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877304",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111078855",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090729800",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348085702",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002004703",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831103",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687027111",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090233401",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008803",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268007611",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090729801",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862064230",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687027121",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518316800",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679096405",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090750600",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789006679",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224012203",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687075321",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862064290",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919077603",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518325402",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862064264",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224012230",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789016930",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332025209",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105065319",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105065301",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332025230",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518325403",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105065305",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187018904",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789044507",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094079930",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094079909",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180086206",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679096401",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180086211",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180016111",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094079903",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071077405",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812503",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094079950",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759803",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452017213",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518316801",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180016113",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180016106",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518059904",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518316900",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452017274",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518059906",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518309401",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008802",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877303",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788907803",
      "ndc_label_name": "Azithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205049103",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518316802",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518059901",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452017272",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189001502",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041201",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518059903",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518059900",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189009003",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804015304",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789006602",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518059902",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420058903",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518059905",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518325401",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518309400",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789006603",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518325400",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205049104",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019603",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205050303",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067403",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205051903",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189009002",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789044502",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789006302",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789044579",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789006607",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425022001",
      "ndc_label_name": "Azithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111078910",
      "ndc_label_name": "Azithromycin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518324900",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291004430",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224022230",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094069030",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687031425",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781809131",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442040330",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687031495",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180086306",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679096201",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332025330",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452017313",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518071300",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291008430",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180016206",
      "ndc_label_name": "Azithromycin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00013010110",
      "ndc_label_name": "Azulfidine Tablet 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00013010130",
      "ndc_label_name": "Azulfidine Tablet 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00013010120",
      "ndc_label_name": "Azulfidine Tablet 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11845009662",
      "ndc_label_name": "B-12 Quick Dissolve Tablet Sublingual 1000 MCG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845009661",
      "ndc_label_name": "B-12 Quick Dissolve Tablet Sublingual 1000 MCG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013858",
      "ndc_label_name": "B-Complex/Vitamin C TABLET Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013935",
      "ndc_label_name": "B-Complex/Vitamin C TABLET ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00713028031",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090084500",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536125628",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784011613",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917005749",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917018788",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802006001",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904740267",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802006003",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59390002601",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802006070",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68001047745",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784011612",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959021703",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090084600",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51672200501",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45861007303",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68788864302",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090081500",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959021706",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49614041810",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71205005701",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66267098830",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59390002617",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59390002662",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777011621",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61919011630",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68001047747",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777011630",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68001047748",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777021901",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72162228002",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66267098915",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777011611",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777011631",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777011610",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71335273101",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777011620",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68001047746",
      "ndc_label_name": "Bacitracin Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00574402235",
      "ndc_label_name": "Bacitracin OINTMENT 500 UNIT/GM OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904702367",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00472110556",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917016408",
      "ndc_label_name": "Bacitracin Zinc OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00472110534",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11527016351",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917016394",
      "ndc_label_name": "Bacitracin Zinc OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904880467",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011354",
      "ndc_label_name": "Bacitracin Zinc OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784011731",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536126328",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784011712",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51824000301",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917014221",
      "ndc_label_name": "Bacitracin Zinc OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784011751",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784011721",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784011733",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16784011761",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "14428000944",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58980001101",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58980001110",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "14428000888",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "21922009104",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090276600",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090327900",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72189006830",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51672207501",
      "ndc_label_name": "Bacitracin Zinc OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896011114",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777000850",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959011303",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "21922009105",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777000820",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959011330",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "79503010730",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51672207502",
      "ndc_label_name": "Bacitracin Zinc OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777000830",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777000860",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959011315",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800008902",
      "ndc_label_name": "Bacitracin Zinc OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777000861",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72189004430",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959011344",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896014514",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777022007",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090470600",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777000811",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61269010534",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777000831",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61269010556",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68001053145",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777000851",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68001053146",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777000810",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69396002701",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67777000821",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68071132400",
      "ndc_label_name": "Bacitracin Zinc OINTMENT 500 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69396000820",
      "ndc_label_name": "Bacitracin Zinc Ointment 500 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31722099801",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115101001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115101003",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904647561",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603240628",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300034301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603240621",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172409680",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086430",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172409660",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603240632",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714007106",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832105415",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090585500",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135053210",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440718030",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090686800",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527133001",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135078110",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086490",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135053201",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090585503",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571017101",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527133010",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090686801",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904755261",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714007104",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999060745",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135078101",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090614903",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571017110",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832105410",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090760100",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090165001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300034310",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090614900",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090165003",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090686900",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571017150",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832105411",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090791300",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090249300",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291015810",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817032010",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090249301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436902201",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700040330",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722099810",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289075760",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090249303",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086460",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817032050",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090585501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817032000",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657073110",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090165000",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050311",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090686803",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090760000",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073390",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090614901",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073300",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651039401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268010615",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687081565",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090760001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268010611",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289075730",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090760003",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651039405",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687081501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436902205",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009386",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436902203",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436902202",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700040360",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436006001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687081511",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002630",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407097301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629212801",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407097310",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154763500",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097490",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073302",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009307",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009372",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073310",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629212901",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073312",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700040390",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700040301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009330",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135047305",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187014730",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739047910",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073318",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002660",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657073101",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187014790",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629122501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187031372",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858408",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073320",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097430",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009314",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651039499",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629128603",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187031378",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518361401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073330",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097460",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009360",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135047390",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818109",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764303",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629128608",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710128505",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073340",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093105",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009390",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187014760",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858406",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764306",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629208201",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205047472",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073360",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002690",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544067192",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187031330",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858409",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818108",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855508",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020603",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289075790",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187014720",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085511",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629128604",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872603",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857201",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020606",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093101",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187014778",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818101",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629128606",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872606",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857203",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857208",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020609",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629128609",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187031320",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855503",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629128607",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872609",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858403",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878306",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335164303",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629208001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187031360",
      "ndc_label_name": "Baclofen TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855506",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739023001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788924608",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878309",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179703",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818103",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187031390",
      "ndc_label_name": "Baclofen TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872608",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544067160",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788924609",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518036200",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788924603",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335239204",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818106",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629122401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512078210",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544067180",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756028811",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205047430",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518280401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066080",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857209",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629128605",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205047414",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764309",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756028812",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205047478",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335975904",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162107909",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878303",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020607",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855509",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179704",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205047490",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092480",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162237301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020601",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764308",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335164307",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857206",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092492",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335239201",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888001005",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047995",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020604",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518036201",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179702",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858401",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930000612",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335975901",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008003",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73320000202",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335164301",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518280400",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335239202",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872601",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162115201",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335975902",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056803",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73320000204",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179701",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710128500",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335239207",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878308",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162244901",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335975907",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804024260",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024130",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963802",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205047460",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335282601",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788924601",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024160",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066060",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001560",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039104",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963804",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020602",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045260",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788924606",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008002",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092453",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005730",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005790",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092460",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020605",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045280",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518308900",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039102",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162244900",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930000613",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710128501",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162107901",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020608",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015602",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205047420",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804024290",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73320000203",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015604",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020600",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015603",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335164302",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039103",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963801",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001590",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039101",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005760",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963807",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179707",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045292",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056801",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162107900",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066092",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056802",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056804",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804024272",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162107908",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804024230",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162237300",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001530",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047901",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789050830",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789050890",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888001000",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888001001",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024190",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015601",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804024278",
      "ndc_label_name": "Baclofen Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115101203",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603240728",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722099905",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086530",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135053301",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172409760",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440718130",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115101201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832105511",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904647661",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090583801",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090180101",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571017210",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172409780",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527133705",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527133701",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135078205",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135053305",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817032110",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959067745",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090583802",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832105515",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603240721",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527133710",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090468201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135078210",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267087260",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700040860",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700040830",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904755361",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603240732",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300034410",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407097410",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571017201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638409",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700040890",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687082601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135078201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135053310",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722099910",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959067760",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714007204",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873706",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657073201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009560",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300034401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571017250",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436902302",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657073210",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090180102",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873708",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687082611",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135047405",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722099901",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714007205",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407097401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090583803",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335275603",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009530",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629122601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086560",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086590",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959067710",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009586",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268010715",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335275606",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788756201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629122801",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436902301",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090468202",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093205",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629208301",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959067790",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039145",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763506",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084086811",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817032150",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090468203",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651039501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267087291",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651039505",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044492",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763509",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638406",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959067702",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268010711",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687051411",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638403",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651039599",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162108009",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788756208",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959067730",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436902303",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009590",
      "ndc_label_name": "Baclofen TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687051401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189056582",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833306",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791503",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009582",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817032100",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629208401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791508",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629122701",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73320000303",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179603",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187027430",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002730",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629213001",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791509",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638408",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020503",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266901",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873709",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187028030",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135047490",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739023301",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857506",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788756206",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739048010",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061460",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518217300",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629213101",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788756203",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873701",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710128605",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788756209",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763503",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092192",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518266200",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084086801",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763508",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756028951",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756028912",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791506",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833303",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930000712",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710128600",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833309",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335094900",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010300",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833308",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857508",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162108000",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710128601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833301",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857509",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335275601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039160",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518266201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010301",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162108003",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010303",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857503",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335221903",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335275602",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044645",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518311500",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061445",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162237400",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010306",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873703",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061492",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039192",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044660",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518311501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162108006",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189056590",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335166401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756028911",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162237406",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044460",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162108001",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335221901",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245000",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73320000302",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162108005",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245002",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189050490",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162237402",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266902",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048090",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024230",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335249701",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162237401",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425011201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189056560",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189050482",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266903",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425011202",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024260",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044692",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189050430",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028201",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888001100",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031290",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044445",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045901",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008102",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930000713",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189050460",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046601",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015701",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015702",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092160",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046602",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046703",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245001",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048095",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046604",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028202",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031230",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048001",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047801",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046704",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888001101",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024290",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047802",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509134403",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73320000304",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888001105",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001860",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001830",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020501",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020502",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006230",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509134406",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028204",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028203",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045903",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509134409",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045904",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046603",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047804",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045902",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001890",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046702",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006260",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046701",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006290",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047803",
      "ndc_label_name": "Baclofen Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300047401",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687080465",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135078001",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162237201",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527133301",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093001",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268010515",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115101101",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268010511",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888000901",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687080411",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407097201",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571016901",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73320000102",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657073001",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710160901",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817031910",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047830",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135047290",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84386003501",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722013801",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093005",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930006612",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047801",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756008511",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162244801",
      "ndc_label_name": "Baclofen Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268010211",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268010213",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789014969",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291015728",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054007928",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407082028",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710162601",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505257507",
      "ndc_label_name": "Balsalazide Disodium CAPSULE 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162209502",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80005012625",
      "ndc_label_name": "Balsalazide Disodium Capsule 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555903458",
      "ndc_label_name": "Balziva TABLET 0.4-35 MG-MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555903479",
      "ndc_label_name": "Balziva TABLET 0.4-35 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002614511",
      "ndc_label_name": "Baqsimi One Pack Powder 3 MG/DOSE Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00548835101",
      "ndc_label_name": "Baqsimi One Pack Powder 3 MG/DOSE Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08290306413",
      "ndc_label_name": "BD Heparin PosiFlush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306423",
      "ndc_label_name": "BD Heparin PosiFlush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290326730",
      "ndc_label_name": "BD Insulin Syringe U-500 31G X 6MM 0.5 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08290303191",
      "ndc_label_name": "BD PosiFlush SafeScrub Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290300649",
      "ndc_label_name": "BD PosiFlush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306546",
      "ndc_label_name": "BD PosiFlush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306544",
      "ndc_label_name": "BD PosiFlush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306553",
      "ndc_label_name": "BD PosiFlush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306545",
      "ndc_label_name": "BD PosiFlush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306499",
      "ndc_label_name": "BD PosiFlush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306547",
      "ndc_label_name": "BD PosiFlush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290256082",
      "ndc_label_name": "BD Veritor System SARS-CoV-2 Kit In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291016101",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440719090",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155075001",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440719030",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090377502",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781189201",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063067990",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063067930",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084130",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033650",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407046301",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155075005",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090575100",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291016150",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090091202",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090091200",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335085404",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268011011",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746075201",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407046305",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760035190",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033610",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268011015",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090377500",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011030",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084160",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118033808",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746075205",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028060",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028030",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304033805",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090575102",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887709",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118033809",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135072090",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075210",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518025200",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075250",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887703",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304033801",
      "ndc_label_name": "Benazepril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518307400",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011090",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887701",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887706",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518025201",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862011601",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181603",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335085401",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181609",
      "ndc_label_name": "Benazepril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090091301",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440719290",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440719230",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291016250",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155075101",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291016201",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324301",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063067790",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324300",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063067730",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155075105",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033750",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033710",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999075930",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268011111",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090575001",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919073990",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090091300",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033703",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071014660",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458086316",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700029190",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268011115",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407046401",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304033905",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304033901",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090575000",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518164001",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135072190",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760035290",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746075305",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039390",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039330",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075350",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407046405",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518317200",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518164000",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071014630",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118033908",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075310",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959083130",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071014690",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118033909",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934022890",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746075301",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934060890",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862011701",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934060830",
      "ndc_label_name": "Benazepril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071014691",
      "ndc_label_name": "Benazepril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155075205",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407046505",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155075201",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959083530",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440719390",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187090690",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291016301",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440719330",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063074830",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075450",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291016350",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118034009",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090335900",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304034001",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033803",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090091400",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268011211",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071002660",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268011215",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862011801",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959083560",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071002690",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033810",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090091401",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304034005",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205032030",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407046501",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071002630",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746075401",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788695709",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033850",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788695701",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784501",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784503",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518212501",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788695703",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458086216",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788695706",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090335901",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784508",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784506",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784509",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518317100",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518212500",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187090630",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746075405",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075410",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118034003",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934054530",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919075690",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135072290",
      "ndc_label_name": "Benazepril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788695708",
      "ndc_label_name": "Benazepril HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268010915",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781189101",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155074905",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407046205",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291016001",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356058790",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407046201",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155074901",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118033709",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356058760",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291016050",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356058730",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075150",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118033703",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033510",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746075101",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268010911",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629267901",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746075105",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075110",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135071990",
      "ndc_label_name": "Benazepril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304033701",
      "ndc_label_name": "Benazepril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574022701",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559041501",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185032501",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980019401",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462057701",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888022001",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268001",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268003",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185021101",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462057801",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574022901",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980019501",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162232801",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888022101",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268002",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559041601",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980019601",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559041701",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185027701",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574022801",
      "ndc_label_name": "Benazepril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959090730",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888022201",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462057901",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559041401",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185023601",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462057601",
      "ndc_label_name": "Benazepril-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00067010624",
      "ndc_label_name": "Benefiber Drink Mix PACKET ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00067002316",
      "ndc_label_name": "Benefiber Drink Mix PACKET ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00067003028",
      "ndc_label_name": "Benefiber Drink Mix PACKET ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00067002416",
      "ndc_label_name": "Benefiber Drink Mix PACKET ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00067002108",
      "ndc_label_name": "Benefiber Drink Mix PACKET ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00067002508",
      "ndc_label_name": "Benefiber Drink Mix PACKET ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00067010724",
      "ndc_label_name": "Benefiber Drink Mix PACKET ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00067003938",
      "ndc_label_name": "Benefiber For Children Powder Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58394063503",
      "ndc_label_name": "BeneFIX KIT 1000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58394063603",
      "ndc_label_name": "BeneFIX KIT 2000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58394063303",
      "ndc_label_name": "BeneFIX KIT 250 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58394063703",
      "ndc_label_name": "BeneFIX KIT 3000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58394063403",
      "ndc_label_name": "BeneFIX KIT 500 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008801",
      "ndc_label_name": "Benlysta Solution Auto-injector 200 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008835",
      "ndc_label_name": "Benlysta Solution Auto-injector 200 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008802",
      "ndc_label_name": "Benlysta Solution Auto-injector 200 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008861",
      "ndc_label_name": "Benlysta Solution Auto-Injector 200 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008842",
      "ndc_label_name": "Benlysta Solution Prefilled Syringe 200 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49401008847",
      "ndc_label_name": "Benlysta Solution Prefilled Syringe 200 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155089801",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904715361",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440718585",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291009150",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079801",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904656460",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722095605",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788002801",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192061701",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155089805",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904656461",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098115",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079806",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098110",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079812",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192061705",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806071401",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722095601",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788002805",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090540901",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079821",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098112",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079815",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291009101",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098001",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806071405",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079810",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002058915",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098082",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321200",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098121",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079820",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436599502",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079830",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063091015",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762112201",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098120",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090540902",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098124",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098030",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959041115",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090322805",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090322800",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429092701",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098130",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090620502",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090322801",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098106",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135044090",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090622800",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090496902",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032520",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090322802",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638702",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090620505",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999029750",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001640",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224001060",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638701",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001620",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090620501",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685000",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224001050",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090540900",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092820",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700055630",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959041110",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001630",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959041120",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092230",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002058910",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090540905",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739002910",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629244301",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760086930",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629247401",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959041130",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919040030",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002058920",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090598600",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084021401",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760703",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057320",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267003321",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429092730",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135044031",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002058930",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090620500",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382024701",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934012130",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187079940",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382024705",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760070015",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332042671",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429092705",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638700",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760700",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205066230",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092821",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760701",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003120",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092810",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760057330",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638705",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760702",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085314",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092830",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760704",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003130",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092814",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760070030",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700055620",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934012115",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088515",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629918901",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518287302",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057315",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877057305",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760086915",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032530",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205063230",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088530",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980063450",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518287303",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057330",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788635705",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003115",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332042631",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162191305",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097130",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084021411",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934067530",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092840",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518287300",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135044001",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187007614",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023021",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069253",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518093001",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085300",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629247301",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518287301",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380071206",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452014330",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267076504",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162156105",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006740",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085321",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877057301",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005830",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380071207",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934012120",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760709",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023015",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205069930",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088555",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452014320",
      "ndc_label_name": "Benzonatate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934012109",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980063401",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205069921",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205063221",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023020",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085355",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097114",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085320",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934067520",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760705",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088514",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085330",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006710",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088500",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097120",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097100",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006715",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085310",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097110",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097155",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006720",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088510",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069260",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335267201",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006730",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088521",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097121",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023115",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205063220",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088520",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162156101",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865011701",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085315",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626020101",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068801",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023006",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097115",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008002330",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023012",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069230",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189019430",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001415",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865011730",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023030",
      "ndc_label_name": "Benzonatate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135063205",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079921",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722095805",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788002705",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192061801",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192061805",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155089905",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722095801",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788002701",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608000",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097901",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155089901",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806071505",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291009201",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090629401",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806071501",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079930",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224000150",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090582301",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608002",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079901",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324600",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700056130",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090582300",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324601",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092330",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608001",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187060621",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090582302",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224000160",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919051720",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090629400",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324602",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135044131",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090629402",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629122901",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002004120",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002004115",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629247501",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919051730",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655077652",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332042771",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919027220",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980063501",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708703",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429091401",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629247601",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135044160",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002004110",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009101",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629244401",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708701",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708706",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919076320",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452014420",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332042731",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002004130",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708702",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380071306",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088620",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812706",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187018510",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934007830",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380071307",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063830",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813303",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812703",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088621",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813302",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877057501",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065920",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812701",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980063550",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813306",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832902",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088700",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833601",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005530",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065921",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812702",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877057505",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832906",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833603",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097210",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840502",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064321",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088614",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813301",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832901",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833602",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833606",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002530",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518249100",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067314",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088721",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840501",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832903",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840503",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452014430",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023221",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518249101",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067330",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097255",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840506",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205060520",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005520",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934007820",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518249102",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205003714",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088610",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162156005",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064330",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205060521",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205003730",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065914",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097214",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205003720",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088615",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162191401",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335072501",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205060530",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205060514",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088714",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335259001",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205003721",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088720",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023230",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088715",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064314",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088730",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335072506",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088755",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065930",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335003101",
      "ndc_label_name": "Benzonatate CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008004130",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097220",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064320",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162156001",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060620",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097230",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088600",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189019230",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865011901",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162131601",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088630",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002521",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088655",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088710",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097215",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097200",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097221",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335285301",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060630",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865011930",
      "ndc_label_name": "Benzonatate Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49022045382",
      "ndc_label_name": "Benzoyl Peroxide GEL 10 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71800004506",
      "ndc_label_name": "Benzoyl Peroxide Gel 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802030896",
      "ndc_label_name": "Benzoyl Peroxide GEL 10 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802030801",
      "ndc_label_name": "Benzoyl Peroxide GEL 10 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959095902",
      "ndc_label_name": "Benzoyl Peroxide Gel 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802010196",
      "ndc_label_name": "Benzoyl Peroxide Gel 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999075045",
      "ndc_label_name": "Benzoyl Peroxide Gel 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802021601",
      "ndc_label_name": "Benzoyl Peroxide GEL 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802021696",
      "ndc_label_name": "Benzoyl Peroxide GEL 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71800004304",
      "ndc_label_name": "Benzoyl Peroxide Gel 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802031801",
      "ndc_label_name": "Benzoyl Peroxide Liquid 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162233702",
      "ndc_label_name": "Benzoyl Peroxide Liquid 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802031834",
      "ndc_label_name": "Benzoyl Peroxide Liquid 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999050808",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573045408",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536126163",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "35573045491",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67405083005",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536135142",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67405083008",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536147442",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 10 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536125919",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536125963",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "35573045391",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67405082505",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "35573045308",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802028034",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802028001",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162233802",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67405082508",
      "ndc_label_name": "Benzoyl Peroxide Wash Liquid 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00603243321",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904728861",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534016709",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135060610",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904678861",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243721",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243332",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687035601",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518072000",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135081301",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629960501",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135014118",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353091309",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243732",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135081310",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687035611",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518169103",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097082607",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013601",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162259401",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518169104",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135060601",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070709",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629213301",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752012311",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162259400",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518168800",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084038111",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385010310",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534016710",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135014157",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013610",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518273202",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228022501",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518169101",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518072002",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518169102",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228022510",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162115501",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518273200",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385010301",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629213201",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518273201",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013601",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752012310",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013610",
      "ndc_label_name": "Benztropine Mesylate TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162259402",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084038101",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518072001",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518168801",
      "ndc_label_name": "Benztropine Mesylate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243821",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440719530",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090311600",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440719592",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058030",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440719560",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135014401",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135081401",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904728961",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440719590",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228022601",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243421",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084038801",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243432",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518057800",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079653",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058053",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243832",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097082707",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904679061",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518057703",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135060701",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013710",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090602200",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228022610",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534016809",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518057700",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135060710",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518088100",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135081410",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518057701",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090701700",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187084003",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534016810",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752012411",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013710",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013701",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079630",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385010401",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687036801",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518057702",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135014410",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518144701",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610050253",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162259500",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518057704",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687036811",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013701",
      "ndc_label_name": "Benztropine Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135014418",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518144702",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135014457",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518144703",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084038811",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752012410",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097082715",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162259502",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518144704",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162259501",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385010410",
      "ndc_label_name": "Benztropine Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243532",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135014210",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243921",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440719660",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440719692",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440719690",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440719630",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904729061",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083215",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385010501",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135060801",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243932",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603243521",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904678961",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228022710",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135081501",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013810",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135060810",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228022701",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135081510",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534016909",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083207",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687037901",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534016910",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090269500",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135014218",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687037911",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518267700",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919012830",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752012511",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629213401",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162259602",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135014201",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013810",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135014257",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629213501",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629942201",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013801",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013801",
      "ndc_label_name": "Benztropine Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084038911",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084038901",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385010510",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518267701",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752012510",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162259600",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162259601",
      "ndc_label_name": "Benztropine Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51552024205",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452102001",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927139100",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779102908",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779102901",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552024207",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592001070",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452102002",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927496100",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592001043",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592001032",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991131802",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452102003",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991131801",
      "ndc_label_name": "Benzyl Alcohol Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452102502",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552085905",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779103009",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991164504",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779103001",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452102503",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452102501",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779103007",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991164502",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927142200",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592003232",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991164505",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552085907",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60592003243",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592003270",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779103008",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592003233",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991164506",
      "ndc_label_name": "Benzyl Benzoate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72162140504",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802037635",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026550",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802037632",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012450",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090209100",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029052",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026515",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724105",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090327000",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205027515",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131001",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162140502",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090523200",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629861301",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629861401",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029017",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131003",
      "ndc_label_name": "Betamethasone Dipropionate Aug CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767005",
      "ndc_label_name": "Betamethasone Dipropionate Aug Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130901",
      "ndc_label_name": "Betamethasone Dipropionate Aug GEL 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999075715",
      "ndc_label_name": "Betamethasone Dipropionate Aug Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356064115",
      "ndc_label_name": "Betamethasone Dipropionate Aug Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130903",
      "ndc_label_name": "Betamethasone Dipropionate Aug GEL 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922010421",
      "ndc_label_name": "Betamethasone Dipropionate Aug Lotion 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026760",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748048030",
      "ndc_label_name": "Betamethasone Dipropionate Aug Lotion 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026730",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672134003",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748048060",
      "ndc_label_name": "Betamethasone Dipropionate Aug Lotion 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922010401",
      "ndc_label_name": "Betamethasone Dipropionate Aug Lotion 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672134004",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118999506",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118999503",
      "ndc_label_name": "Betamethasone Dipropionate Aug LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993089749",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180094701",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026815",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026850",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472038215",
      "ndc_label_name": "Betamethasone Dipropionate Aug OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090751700",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573010715",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472038245",
      "ndc_label_name": "Betamethasone Dipropionate Aug OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573010749",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739099665",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090678700",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180094702",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993089715",
      "ndc_label_name": "Betamethasone Dipropionate Aug Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168005515",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090023500",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472038015",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713065915",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714099602",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090403800",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168005546",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472038045",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090037300",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090327600",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713075937",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713065937",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090218200",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002094163",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714099601",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713075915",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672127406",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090183900",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672127401",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407027315",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072115",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407027345",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090468000",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710123301",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090752500",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002094167",
      "ndc_label_name": "Betamethasone Dipropionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072145",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710123304",
      "ndc_label_name": "Betamethasone Dipropionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713080753",
      "ndc_label_name": "Betamethasone Dipropionate LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168005760",
      "ndc_label_name": "Betamethasone Dipropionate LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713072853",
      "ndc_label_name": "Betamethasone Dipropionate Lotion 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802002146",
      "ndc_label_name": "Betamethasone Dipropionate LOTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748047560",
      "ndc_label_name": "Betamethasone Dipropionate Lotion 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168005615",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472038115",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802050514",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629932301",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578009301",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168005646",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959096250",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802050584",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356049615",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472038145",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002072363",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267129601",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629932401",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817082415",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162141502",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090023600",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817082445",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002072367",
      "ndc_label_name": "Betamethasone Dipropionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335271501",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959026200",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162141504",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959026215",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578009306",
      "ndc_label_name": "Betamethasone Dipropionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090030901",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090379401",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472037015",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168004046",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168004015",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904077645",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672126906",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472037045",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164700",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845001",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313401",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090023700",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713032615",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002092167",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518313700",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713032637",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002092163",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845004",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959026300",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672126901",
      "ndc_label_name": "Betamethasone Valerate CREAM 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004015",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731204",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731201",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090469600",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959026301",
      "ndc_label_name": "Betamethasone Valerate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959024303",
      "ndc_label_name": "Betamethasone Valerate Lotion 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168004160",
      "ndc_label_name": "Betamethasone Valerate Lotion 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54879000460",
      "ndc_label_name": "Betamethasone Valerate Lotion 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002084563",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782701",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472037115",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168003346",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168003315",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205036415",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472037145",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713032715",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849601",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782704",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713032737",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849604",
      "ndc_label_name": "Betamethasone Valerate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135051601",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832051101",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527134001",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155093501",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746057201",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084036501",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068901",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832051189",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832051100",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084036511",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135075612",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068911",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293064601",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335084601",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629202301",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629929301",
      "ndc_label_name": "Bethanechol Chloride Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162057210",
      "ndc_label_name": "Bethanechol Chloride TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135051701",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832051201",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527135601",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135051705",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155093601",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832051200",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687070001",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832051289",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980016201",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135075712",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293064701",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162057310",
      "ndc_label_name": "Bethanechol Chloride TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746057301",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904617861",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687070011",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629202401",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084070401",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084070411",
      "ndc_label_name": "Bethanechol Chloride Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527133201",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135075590",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980016001",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293064501",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155093401",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832051000",
      "ndc_label_name": "Bethanechol Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746057101",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135051501",
      "ndc_label_name": "Bethanechol Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162057110",
      "ndc_label_name": "Bethanechol Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629202201",
      "ndc_label_name": "Bethanechol Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980016301",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293064801",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832051389",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162057410",
      "ndc_label_name": "Bethanechol Chloride TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832051301",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135051801",
      "ndc_label_name": "Bethanechol Chloride TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155093701",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527132901",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135075812",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746057401",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832051300",
      "ndc_label_name": "Bethanechol Chloride TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629202501",
      "ndc_label_name": "Bethanechol Chloride Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714081602",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429017701",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429017730",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429017705",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505264203",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729002301",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904601946",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714081601",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729002310",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407001030",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175013232",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559089030",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804008290",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505264201",
      "ndc_label_name": "Bicalutamide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335048583",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518299300",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335048588",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518299301",
      "ndc_label_name": "Bicalutamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958250501",
      "ndc_label_name": "Biktarvy Tablet 30-120-15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958250601",
      "ndc_label_name": "Biktarvy Tablet 30-120-15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518308001",
      "ndc_label_name": "Biktarvy Tablet 50-200-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090624700",
      "ndc_label_name": "Biktarvy Tablet 50-200-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518308002",
      "ndc_label_name": "Biktarvy Tablet 50-200-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958250103",
      "ndc_label_name": "Biktarvy Tablet 50-200-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518308000",
      "ndc_label_name": "Biktarvy Tablet 50-200-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958250101",
      "ndc_label_name": "Biktarvy TABLET 50-200-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571012835",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505058301",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862080205",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332050725",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862080244",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571012821",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571012828",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266024101",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505058304",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069040301",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069040101",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332050705",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266014001",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180042903",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862080210",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180042901",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180042902",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069040201",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266013901",
      "ndc_label_name": "Bimatoprost Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689012905",
      "ndc_label_name": "Bisacodyl Tablet Delayed Release 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "24689012903",
      "ndc_label_name": "Bisacodyl Tablet Delayed Release 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "24689012902",
      "ndc_label_name": "Bisacodyl Tablet Delayed Release 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69618002903",
      "ndc_label_name": "Bismuth Subsalicylate TABLET CHEWABLE 262 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904720546",
      "ndc_label_name": "Bismuth Subsalicylate Tablet Chewable 262 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52817027130",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714053001",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980071001",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407064630",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547061703",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300012701",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862008701",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300012713",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578011206",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714053002",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039582",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70095001901",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817027110",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407064601",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954045620",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547061710",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332060430",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578011201",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70095001902",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980071003",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888009330",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332060431",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862008730",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888009301",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954045610",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714052901",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547061610",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407064501",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300012601",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268012711",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862008630",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714052902",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300012613",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817027030",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999086600",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067921",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332060330",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817027010",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954045520",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067911",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547061603",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187087190",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407064530",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70095002001",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980070901",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919078790",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578011101",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888009201",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268012715",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980070903",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954045510",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332060331",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888009230",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862008601",
      "ndc_label_name": "Bisoprolol Fumarate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578011106",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867101",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70095002002",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162217701",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039282",
      "ndc_label_name": "Bisoprolol Fumarate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300018913",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 10-6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300018901",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 10-6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378050505",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462088001",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093324356",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135074230",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135074205",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378050501",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799092201",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959024130",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518194700",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578011506",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300018905",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 10-6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799092202",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090079900",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799092230",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462088030",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578011501",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518320700",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954041430",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090603000",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590500",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954041440",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462088005",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518194701",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578011505",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954041410",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 10-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135074001",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954041210",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090079600",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093324101",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378050101",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135074005",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300018705",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 2.5-6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300018701",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 2.5-6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378050105",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462087830",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090647800",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799092001",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300018713",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 2.5-6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954041240",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799092030",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578011306",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799092002",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462087801",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462087805",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954041230",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518333300",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578011301",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578011305",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300018801",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578011406",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300018805",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300018813",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093324201",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378050305",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090078900",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584902",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799092102",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135074105",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584900",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462087901",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378050301",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799092101",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090641300",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033730",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090078902",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799092130",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090641302",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289063030",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135074101",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954041310",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735700",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462087930",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735702",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954041340",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289063090",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide TABLET 5-6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954041330",
      "ndc_label_name": "Bisoprolol-Hydrochlorothiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578011401",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578011405",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033710",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462087905",
      "ndc_label_name": "Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11169020011",
      "ndc_label_name": "Blis-To-Sol Liquid 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11169020012",
      "ndc_label_name": "Blis-To-Sol Liquid 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090183100",
      "ndc_label_name": "Boostrix Suspension 5-2.5-18.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160084201",
      "ndc_label_name": "Boostrix Suspension 5-2.5-18.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160084211",
      "ndc_label_name": "Boostrix Suspension 5-2.5-18.5 LF-MCG/0.5 Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591251260",
      "ndc_label_name": "Bosentan Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382044714",
      "ndc_label_name": "Bosentan Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335003986",
      "ndc_label_name": "Bosentan Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884005902",
      "ndc_label_name": "Bosentan Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335003886",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054052021",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591251160",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382044614",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884005802",
      "ndc_label_name": "Bosentan Tablet 62.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "92961002003",
      "ndc_label_name": "BrainStrong Prenatal 33-0.8 & 350 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70914003610",
      "ndc_label_name": "Breathe Ease Neb Mask/Child",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70914003600",
      "ndc_label_name": "Breathe Ease Neb Mask/Infant",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70914003620",
      "ndc_label_name": "Breathe Ease Neb Mask/Infant",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378750332",
      "ndc_label_name": "Breyna Aerosol 160-4.5 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378750232",
      "ndc_label_name": "Breyna Aerosol 80-4.5 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24208041115",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921018510",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314014310",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071510",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071511",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314014305",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208041110",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090104600",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090636800",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921018515",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069023201",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071512",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069023301",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208041105",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314014315",
      "ndc_label_name": "Brimonidine Tartrate SOLUTION 0.2 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069023101",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921018505",
      "ndc_label_name": "Brimonidine Tartrate Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304015801",
      "ndc_label_name": "Bromocriptine Mesylate CAPSULE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378709693",
      "ndc_label_name": "Bromocriptine Mesylate CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382011001",
      "ndc_label_name": "Bromocriptine Mesylate Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378709601",
      "ndc_label_name": "Bromocriptine Mesylate CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382011006",
      "ndc_label_name": "Bromocriptine Mesylate CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304015830",
      "ndc_label_name": "Bromocriptine Mesylate CAPSULE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687028611",
      "ndc_label_name": "Bromocriptine Mesylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781532501",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574010603",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574010601",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954097820",
      "ndc_label_name": "Bromocriptine Mesylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304096201",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781532531",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687028621",
      "ndc_label_name": "Bromocriptine Mesylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304096230",
      "ndc_label_name": "Bromocriptine Mesylate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954097810",
      "ndc_label_name": "Bromocriptine Mesylate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72579001102",
      "ndc_label_name": "Brukinsa Capsule 80 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83490044068",
      "ndc_label_name": "Bubbles The Fish II Pedi Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00378715501",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980025501",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162247301",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407059101",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574985510",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904731310",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714082901",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079002003",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079002001",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687059633",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862058001",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407012801",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687059632",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162077810",
      "ndc_label_name": "Budesonide CAPSULE DELAYED RELEASE PARTICLES 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382072001",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746077810",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429026401",
      "ndc_label_name": "Budesonide Capsule Delayed Release Particles 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019800",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019804",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309704",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10695012405",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779276904",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309700",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019803",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779276900",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927447500",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309706",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552136505",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129104",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779276906",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309703",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019805",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779276903",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592002710",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991299702",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991299704",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117904",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129102",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129103",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779019806",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779276905",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117903",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129201",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129105",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991117905",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129205",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129202",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552136501",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779309705",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981001701",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129204",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592002701",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129101",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129206",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452129203",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592002705",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052027001",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552136503",
      "ndc_label_name": "Budesonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991299703",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592002711",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592002725",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052027005",
      "ndc_label_name": "Budesonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093681545",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093681573",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788729003",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093681519",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115168776",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115168774",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093681555",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487960101",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487960130",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090146700",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714001830",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980063803",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781751514",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781751587",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097031887",
      "ndc_label_name": "Budesonide SUSPENSION 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714001805",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097031832",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842903",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282064037",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335063149",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097031853",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090659000",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097031886",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090717300",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135082284",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282064038",
      "ndc_label_name": "Budesonide Suspension 0.25 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714001930",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487970101",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093681619",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093681655",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180098430",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093681673",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093681645",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115168976",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335063249",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487970130",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115168974",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731403",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097031986",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781751687",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781751614",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052483",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651058505",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714001905",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090712600",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097031953",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282064137",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090658600",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135082384",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282064138",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651058530",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052479",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980063903",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180098405",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097031932",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097031987",
      "ndc_label_name": "Budesonide SUSPENSION 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204001801",
      "ndc_label_name": "Budesonide Suspension 0.5 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536111248",
      "ndc_label_name": "Budesonide Suspension 32 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536145684",
      "ndc_label_name": "Budesonide Suspension 32 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917018320",
      "ndc_label_name": "Budesonide SUSPENSION 32 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60505612902",
      "ndc_label_name": "Budesonide SUSPENSION 32 MCG/ACT NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00310737020",
      "ndc_label_name": "Budesonide-Formoterol Fumarate Aerosol 160-4.5 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518310700",
      "ndc_label_name": "Budesonide-Formoterol Fumarate Aerosol 160-4.5 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090632700",
      "ndc_label_name": "Budesonide-Formoterol Fumarate Aerosol 160-4.5 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310737220",
      "ndc_label_name": "Budesonide-Formoterol Fumarate Aerosol 80-4.5 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638200",
      "ndc_label_name": "Budesonide-Formoterol Fumarate Aerosol 80-4.5 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832054011",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469022101",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799011901",
      "ndc_label_name": "Bumetanide TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185012805",
      "ndc_label_name": "Bumetanide TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185012801",
      "ndc_label_name": "Bumetanide TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773600",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "14539070005",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571067901",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603029701",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714083101",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672422301",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090630800",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "14539070001",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547089610",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090566400",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238148901",
      "ndc_label_name": "Bumetanide TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268013015",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268013011",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756007911",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382052501",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888001901",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162219501",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282079701",
      "ndc_label_name": "Bumetanide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714083201",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904701661",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268013115",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185012901",
      "ndc_label_name": "Bumetanide TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185012905",
      "ndc_label_name": "Bumetanide TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904701606",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832054111",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547089710",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090566602",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038411",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672422401",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "14539070101",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904701604",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714083202",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155090105",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268013111",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382052605",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238149005",
      "ndc_label_name": "Bumetanide TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382052601",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571067801",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "14539070105",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155090101",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756008011",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038465",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001601",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001603",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238149001",
      "ndc_label_name": "Bumetanide TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799012002",
      "ndc_label_name": "Bumetanide TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090613802",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799012001",
      "ndc_label_name": "Bumetanide TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162219601",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038495",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001604",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547089750",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282079801",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028809",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090634502",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335292001",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603029802",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001602",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011990",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162219605",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469022201",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038401",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038425",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603029801",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756008051",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888002001",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335267001",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469022205",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282079805",
      "ndc_label_name": "Bumetanide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185013001",
      "ndc_label_name": "Bumetanide TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353029216",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "14539070205",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687053501",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571067701",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155090205",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714083302",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185013005",
      "ndc_label_name": "Bumetanide TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832054211",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090785400",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799012101",
      "ndc_label_name": "Bumetanide TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687053511",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735000",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382052701",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547089810",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720230",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832064211",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268013215",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090613700",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518319100",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335299801",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888002101",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090787600",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714083301",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "14539070201",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238149105",
      "ndc_label_name": "Bumetanide TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090630400",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756008151",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799012102",
      "ndc_label_name": "Bumetanide TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469022301",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268013211",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155090201",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687053565",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756008111",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382052705",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547089850",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162219701",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162219705",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238149101",
      "ndc_label_name": "Bumetanide TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090506400",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335270503",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603029901",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603029902",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090566300",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282079905",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672422501",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518267800",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282079901",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469022305",
      "ndc_label_name": "Bumetanide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700030230",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121101930",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518221700",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162134403",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268012811",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406701203",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228315603",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 2 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054017613",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 2 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335095002",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904715404",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222600",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629712502",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629712501",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383092493",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858050103",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222602",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222603",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687048111",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222601",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335095001",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268012815",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687048121",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629947501",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335095003",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189058060",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756045983",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888018230",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189057960",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189058090",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157100",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904715504",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518162500",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406701803",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228315303",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 8 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858050203",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054017713",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 8 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090580500",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090292400",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756046083",
      "ndc_label_name": "Buprenorphine HCl TABLET SUBLINGUAL 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189058260",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049211",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268012915",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090755900",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121203830",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049221",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518201400",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335116303",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383093093",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629712602",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518221800",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268012911",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335116301",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518201401",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888018330",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335116302",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629712601",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162134503",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335115403",
      "ndc_label_name": "Buprenorphine HCl Tablet Sublingual 8 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121101830",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228315403",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335151401",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014415",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 2-0.5 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406800503",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054018813",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 2-0.5 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335129601",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904700906",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858060103",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014411",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 2-0.5 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429058630",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162041603",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 2-0.5 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175045232",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729054910",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629948201",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383029493",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756096983",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090130",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518100700",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687062611",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162134603",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687062665",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406802003",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518312900",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228315503",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858060203",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383028793",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429058730",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054018913",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 8-2 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121203630",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063765",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185802",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175045832",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014515",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629948301",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756097083",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729055010",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904701006",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518231100",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335282801",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162134703",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162041503",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl TABLET SUBLINGUAL 8-2 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014511",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335172502",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063711",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185801",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518338900",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335137801",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335172501",
      "ndc_label_name": "Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365740",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238120302",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365721",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858049340",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781040704",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505707705",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037404",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037401",
      "ndc_label_name": "Buprenorphine Patch Weekly 10 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858058640",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365840",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037504",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365821",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781041904",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037501",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238120402",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505707805",
      "ndc_label_name": "Buprenorphine Patch Weekly 15 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238120502",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365940",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365921",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781040804",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037601",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505707905",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858083940",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037604",
      "ndc_label_name": "Buprenorphine Patch Weekly 20 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238120202",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037204",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365621",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858075040",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365640",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037201",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781040604",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505707505",
      "ndc_label_name": "Buprenorphine Patch Weekly 5 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238150502",
      "ndc_label_name": "Buprenorphine Patch Weekly 7.5 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037301",
      "ndc_label_name": "Buprenorphine Patch Weekly 7.5 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858035340",
      "ndc_label_name": "Buprenorphine Patch Weekly 7.5 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505707605",
      "ndc_label_name": "Buprenorphine Patch Weekly 7.5 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093323921",
      "ndc_label_name": "Buprenorphine Patch Weekly 7.5 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093323940",
      "ndc_label_name": "Buprenorphine Patch Weekly 7.5 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742037304",
      "ndc_label_name": "Buprenorphine Patch Weekly 7.5 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090510101",
      "ndc_label_name": "buPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598086360",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090732200",
      "ndc_label_name": "buPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090510100",
      "ndc_label_name": "buPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090732201",
      "ndc_label_name": "buPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090115000",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591354376",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591354360",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806041360",
      "ndc_label_name": "buPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090115001",
      "ndc_label_name": "BuPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591354005",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353053882",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904709961",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722006660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722006601",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806041001",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904727061",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591354060",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335073688",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547028810",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722006605",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806041005",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806042401",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073582",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806041060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547028850",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002150903",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674300",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353053816",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598075101",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073518",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090713000",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806042460",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228017405",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003660",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228017401",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335073686",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090258400",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598075105",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090734900",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598075160",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228017460",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781909",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187095260",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090282000",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090296400",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788717009",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335073613",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651084605",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436005801",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788717003",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651084601",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002150906",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002150900",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781906",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084069701",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205038730",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518264100",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097087707",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187095214",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788717006",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187017660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436005802",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084069711",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205038760",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187095230",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305800",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189005730",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189005760",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629319603",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789015860",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781903",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771017405",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335186601",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771017460",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353064060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720030",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720081",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720090",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720091",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806041505",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591354105",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547028910",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720092",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722006705",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806042501",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720085",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591354125",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806041560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904721461",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335073713",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591354160",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806041501",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054680",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806042505",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904658561",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547028950",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722006760",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090307800",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904746561",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063074430",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598075205",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086100",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722006701",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324902",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063091330",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324900",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054630",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353064030",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086101",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086201",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090345300",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090385401",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324903",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598075260",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335073786",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086102",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090635301",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353064080",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090385400",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687100",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687101",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086103",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086200",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086202",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187072630",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598075201",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090385402",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687103",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651084701",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324901",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090635300",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086203",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544029930",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335073788",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090385403",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742202",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187005260",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687102",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090635303",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228017501",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876902",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090635302",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090635400",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742203",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544029980",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687200",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742201",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002134503",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876903",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228017560",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742200",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742300",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780702",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080630",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700089560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335013501",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002134506",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228017505",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084070895",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780709",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002134500",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013630",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013660",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335013507",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700089530",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651084705",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780703",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934015190",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629847301",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187005278",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187072660",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934079130",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003830",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006360",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780706",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544029960",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187072690",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876901",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544029953",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187005230",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780701",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205055030",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071012260",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071012230",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436005922",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934015130",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084070825",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205055060",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934015696",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780708",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876906",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934079160",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205056530",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876908",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000601",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205056560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057680",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436005901",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876909",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000602",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000604",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436005902",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000606",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000603",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000605",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934015160",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518307900",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000607",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335013503",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335013504",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183703",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335245701",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335170201",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335013506",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518331800",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335245703",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335170203",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057630",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034930",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057080",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934015196",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162152905",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934079190",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034960",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335013502",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335013505",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183701",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771017505",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771017560",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353090083",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722006860",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335073886",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591354260",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018983",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598075360",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722006801",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806041160",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547029010",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806042660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779303",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728309",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228017660",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651084801",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228017601",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335073888",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779301",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187017860",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771017660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779309",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779302",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728301",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002153603",
      "ndc_label_name": "BuPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651084860",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187056660",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728302",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779306",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728303",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728306",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728308",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779308",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436006001",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058283",
      "ndc_label_name": "buPROPion HCl ER (SR) Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527241532",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904750561",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591333105",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904750504",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904708461",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781552810",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591333119",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527241546",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527241541",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135070305",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904708404",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979010107",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086209",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291018250",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781552831",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135070330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591333130",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090711002",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370010103",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090404902",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044316",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090404900",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086212",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135070390",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086203",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090711300",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370010150",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090678900",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034809",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090474700",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291018230",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044310",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090137202",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020605",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086250",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228014405",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034830",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090474702",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034805",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044315",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090617301",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002149503",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979010106",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228014430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598065505",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090516302",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806041430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979010102",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090711301",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657071090",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806041405",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228014490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313900",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090711000",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063038790",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806041409",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771200",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687078201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598065530",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268013311",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090617300",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090711200",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598065590",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090290400",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817034590",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919055872",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090617302",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268013313",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014011",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771100",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090137200",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090516300",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187071330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919058930",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090710900",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687031201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002149500",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771102",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090137201",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090516301",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187076630",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919058960",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014013",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687031211",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687078211",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020630",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090404901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090711302",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679010205",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629213701",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020690",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006960",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002149509",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090474701",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771101",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180031906",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679010201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657071030",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304072390",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187071390",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657071230",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090711001",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700084930",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775608",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180031902",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657071290",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679010202",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001051903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919067430",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817034550",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782009",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382035306",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919055890",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001061303",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001051904",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187076690",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657071050",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001051905",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518236502",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788401009",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135087530",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071202306",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001061305",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304072305",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657071250",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782001",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205050430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775606",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180031909",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382035316",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782003",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304072330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097007112",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096730",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775609",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778601",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788401001",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747908",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367028809",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629213601",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078409",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789037790",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778606",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778608",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788401006",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778603",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69680015790",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629847401",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518263701",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030003",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778609",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782006",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747906",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69680015792",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078403",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001061304",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934072430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046103",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097087502",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782008",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747909",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078405",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436001006",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382035305",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004590",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518245802",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097087512",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518263700",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775601",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162152605",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518245801",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788401003",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335237801",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189013490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436001004",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934072490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367028805",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771014490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096790",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054360",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046101",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518085900",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004530",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436001002",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775603",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162121803",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096755",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189013472",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097087505",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335246901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030001",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205007690",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518205100",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162121805",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009005105",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189025290",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518245800",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516003550",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301002404",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205039490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518245803",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162152603",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029130",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771014405",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029190",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030190",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610034660",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205050490",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301002403",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789012090",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771014430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030002",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335246903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046102",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008008230",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804008090",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301002401",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301002402",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781552910",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527243032",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598065605",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527243046",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135070490",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086309",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135070405",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527243041",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781552931",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135070430",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963014205",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904657304",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063038890",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044415",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044410",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904746904",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979010202",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370010203",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090105901",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806041630",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963014290",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979010206",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044416",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086303",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034905",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370010250",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090474901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090105900",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090533401",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291018330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806041609",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086350",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090696200",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979010207",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817034690",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272100",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014111",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291018350",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228014505",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806034909",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228014530",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272101",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002150803",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090533400",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700014330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598065630",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817034650",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806041605",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020730",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090474900",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700082090",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090625800",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700014360",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963014230",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135087630",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090524500",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020790",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090625801",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629213901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090696100",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700082030",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090524501",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629331601",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733401",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657071190",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733400",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180032009",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090696101",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657071150",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268013413",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001032105",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090760200",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657071350",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228014590",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788712106",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733500",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081930",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079311",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084025221",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700014390",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187052130",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020705",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788712109",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268013411",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304072430",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079321",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788750901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657071130",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304072490",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657071330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799203",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014115",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629331602",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629331604",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799208",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657071390",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629331603",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187017930",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799206",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304072405",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629331605",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001032103",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827208",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001052003",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001032104",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629213801",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858908",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180032002",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084025211",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788750903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853701",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001052005",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001052004",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629847501",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881503",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788750909",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180032006",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788750906",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867703",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001061404",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001061405",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629847601",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097007212",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827206",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788712101",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788750908",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078503",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786303",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739013233",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078509",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853709",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788712108",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786301",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518277200",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827203",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367028905",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001061403",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436001102",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858909",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786306",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786308",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518277202",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097087602",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436001106",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071131100",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518233200",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867701",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786309",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799209",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335082401",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367028909",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934080430",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382035406",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934075890",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867706",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799201",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335249901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096830",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096890",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788712103",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205046590",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881508",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827209",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012430",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068701",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335082403",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853703",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096855",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078505",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853708",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881509",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771014590",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335231203",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046802",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853706",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121401",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205024830",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867708",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69680015892",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046801",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162121903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881501",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858906",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013130",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012472",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881506",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518089700",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009005205",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162121905",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097087612",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867709",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162152703",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053902",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436001104",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518122900",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301002502",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162152705",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013160",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205046530",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789011290",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771014530",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189053930",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518277201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053903",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301002503",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771014505",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053901",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518277203",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033101",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335082405",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335111403",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335231201",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162127809",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189053990",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516003650",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282048130",
      "ndc_label_name": "BuPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046803",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804001330",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301002501",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301002504",
      "ndc_label_name": "buPROPion HCl ER (XL) Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904663661",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155019201",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720430",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720460",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689012001",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057583",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014311",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904753060",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090751103",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353076753",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353076760",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335018202",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090751100",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090078503",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651087501",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099430",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065502",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353076783",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353076770",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353076780",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065540",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090186900",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687035111",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090078500",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002141706",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353076792",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002141700",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436910102",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429074701",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090186903",
      "ndc_label_name": "BuPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544089753",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065590",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077930",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014315",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002141703",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505015701",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687035101",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065500",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544089760",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135072490",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001030900",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065530",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760078130",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267061430",
      "ndc_label_name": "BuPROPion HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980020201",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731903",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544089780",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731901",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798806",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065560",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798803",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016483",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731908",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731906",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544089783",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332012731",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189045730",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731909",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798809",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335269001",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518158400",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335287501",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335018201",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007090",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007030",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162240101",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518158401",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162209701",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070880",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804012330",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789054490",
      "ndc_label_name": "buPROPion HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904663561",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155019101",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689011901",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057453",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720330",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057470",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720360",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057494",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904752960",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518293400",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356073530",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429074601",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057488",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014211",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959089860",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002144700",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063088030",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335286701",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063088060",
      "ndc_label_name": "BuPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980020101",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003760",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335079107",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651087401",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002144703",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268014215",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037253",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057480",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086660",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804012730",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077480",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505015801",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086680",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002144706",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037270",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687034001",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162240001",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135072390",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089980",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518156600",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089953",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037294",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077453",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687034011",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077470",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089960",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086670",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037280",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332011831",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038494",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001030800",
      "ndc_label_name": "BuPROPion HCl TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077494",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038480",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086653",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162209801",
      "ndc_label_name": "buPROPion HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720730",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720760",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904712161",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720790",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788005905",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155002405",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093005405",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093005401",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689090705",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729020216",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689090701",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788005901",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061070",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024501",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378115001",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378115005",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006060",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155002401",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806008405",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806066301",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090418200",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806008401",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729020201",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063078590",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090211001",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024505",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061060",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806066305",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090534701",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006080",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006053",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006070",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090211004",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543074207",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061080",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090277300",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090664901",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061053",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999081200",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090211000",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090418203",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006092",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061092",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326004",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187090460",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326001",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090418201",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090211003",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576203",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090211005",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326000",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090534700",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382018105",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090418205",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576200",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316800",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407041505",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090534704",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326003",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090534703",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808603",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576205",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959067690",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090418204",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700052690",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020205",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326005",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090664900",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808606",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090786400",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060030",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090534705",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687081211",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083730",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576201",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090664903",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117004101",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060090",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788701703",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576204",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060060",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083790",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090664904",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090664905",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584009250",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629241001",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518068000",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090671900",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187090490",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651039101",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407041501",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079098601",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518203100",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380074206",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518153000",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687081201",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788503",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267052890",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959067660",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079098620",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335975801",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267052820",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335975804",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380074207",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788892906",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788506",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629241101",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020201",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020853",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382018101",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025780",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788701701",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020880",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788509",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380074208",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651039105",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028180",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788701709",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030253",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788701706",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030270",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788892903",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267052845",
      "ndc_label_name": "BusPIRone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187090430",
      "ndc_label_name": "BusPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030292",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584009210",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059692",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788501",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059670",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518153001",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808609",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117004102",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059660",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518203101",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095353",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808601",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096253",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335975803",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788892901",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518327900",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095370",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518203102",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095380",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788892909",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017590",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025753",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335975806",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335167302",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888006401",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934018490",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044860",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238111701",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189020082",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025760",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020860",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335975802",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804010430",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028153",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014001",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030260",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834026801",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030280",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028160",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335975805",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096200",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059680",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095360",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096260",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804010460",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097453",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017530",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059653",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096211",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096280",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096260",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096270",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096255",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097492",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095392",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096292",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044830",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162192501",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097480",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097430",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044890",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018190",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771023601",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097460",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834026805",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162192505",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771023605",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044882",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096272",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888006405",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096230",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096290",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008002930",
      "ndc_label_name": "busPIRone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720860",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378116505",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155002506",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093100305",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788006001",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806008501",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093100301",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689092101",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720890",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378116580",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155002508",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904689961",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155002501",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353060760",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720830",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300047705",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729020312",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378116591",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689092106",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729020301",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689092105",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353060780",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024605",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300047716",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024618",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788006005",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806066401",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300047701",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024601",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090697101",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024616",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806066405",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806008505",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155002505",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079096001",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090211103",
      "ndc_label_name": "BusPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543074318",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760054860",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300047718",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090716101",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090211101",
      "ndc_label_name": "BusPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353060730",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407041660",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090465701",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090465703",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187040290",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090716103",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090729303",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090618801",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090588601",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071390",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090588603",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090729301",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787509",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090729300",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380074318",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268013515",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090618803",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700080360",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090697103",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071345",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788976606",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020305",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788976601",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700086960",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071300",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687082311",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268013511",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651039205",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518309100",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700086990",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584009310",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629241201",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071330",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380074303",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079096020",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057972",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205028090",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057960",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518068103",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629241301",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071360",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796806",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020360",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382018205",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335160503",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187040230",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335175204",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746206",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651039201",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788976603",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407041605",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787501",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335257603",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787503",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834026960",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746209",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057930",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117004204",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687082301",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787506",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335257604",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868103",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117004202",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796809",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057990",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584009350",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238111801",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796803",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020660",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868106",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518297700",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868101",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382018201",
      "ndc_label_name": "BusPIRone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518266000",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518298700",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238111806",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189023560",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868109",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020630",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117004203",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796801",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335175201",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610029160",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518038000",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771023760",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117004201",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097560",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518040100",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788976609",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610029960",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033260",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205028030",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018353",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584009306",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038701",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518297701",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018360",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610034453",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038703",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335175203",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610029953",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518105001",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096360",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518298701",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610029992",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888006501",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064030",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335206004",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064060",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189023590",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064080",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518309101",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189062030",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834026901",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189062090",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610029930",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888006505",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030301",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834026905",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610029980",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096300",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162192601",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096311",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064092",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096330",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189023530",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096355",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162192605",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014101",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189062060",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888006560",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771023705",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030302",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038702",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030303",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096372",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096390",
      "ndc_label_name": "busPIRone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378114001",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378114005",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093005305",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155002301",
      "ndc_label_name": "BusPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788005705",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093005301",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720660",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904712261",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024401",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720630",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440720690",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353060953",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729020001",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788005701",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806008201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155002305",
      "ndc_label_name": "BusPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090579702",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543074107",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689078101",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407041301",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806008205",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729020016",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353060960",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024405",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020105",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806066205",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090768202",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651038901",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353060980",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689078105",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700093730",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518272400",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919016630",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090579701",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407041305",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919016690",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079098501",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806066201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380074107",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079990",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629240801",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079098520",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079960",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919096590",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651038905",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090768201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380074108",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020380",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629240901",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020101",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026760",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382018001",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919016660",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382018005",
      "ndc_label_name": "BusPIRone HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117004001",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026780",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380074106",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065430",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030760",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698403",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698409",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518140400",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238111501",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030753",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698401",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610060460",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698406",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795209",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026753",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082630",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834026605",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584009110",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795206",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610060480",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795203",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205049390",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030792",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082653",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425033403",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026660",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117004002",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888006205",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518068201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335056203",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082660",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094380",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096100",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610060492",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584009150",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096130",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518192401",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020360",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095930",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096190",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096111",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094392",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016553",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005630",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016560",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026653",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013901",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095960",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096172",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030780",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020353",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095980",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016580",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082680",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425033401",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095992",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026680",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094353",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425033402",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162192405",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610060453",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094360",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804006290",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189062890",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013960",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095953",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771023405",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888006201",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050503",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162192401",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834026601",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771023401",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050501",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050502",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096155",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096160",
      "ndc_label_name": "busPIRone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781062801",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 50-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573045602",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 50-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603254021",
      "ndc_label_name": "Butalbital-Acetaminophen TABLET 50-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68047072130",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 50-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752014810",
      "ndc_label_name": "Butalbital-Acetaminophen Tablet 50-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68047072101",
      "ndc_label_name": "Butalbital-Acetaminophen TABLET 50-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440721130",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019402",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019406",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629315201",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991007301",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod CAPSULE 50-325-40-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054300001",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019407",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591322001",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod CAPSULE 50-325-40-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629315202",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019403",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019401",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019404",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162159102",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959091260",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019405",
      "ndc_label_name": "Butalbital-APAP-Caff-Cod Capsule 50-325-40-30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527169501",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904693806",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591336905",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527169505",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027560",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603254428",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591336901",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603254421",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781062505",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090704203",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090210500",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023630",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781062501",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702025350",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027553",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702025301",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187052030",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268055311",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090210503",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023653",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090704200",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436169501",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436485602",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023660",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187093314",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067265",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092030",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027530",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090751900",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436485601",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429058905",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023670",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752014210",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629177409",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760086512",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027570",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055605",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002230",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067211",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256400",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098130",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693901",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002260",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256403",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862054001",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693908",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187093330",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268055313",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036504",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879403",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002290",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700066230",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092012",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813703",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084039611",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407055601",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036505",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010014901",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629215101",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429058901",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629214001",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036503",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813702",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862054005",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335227002",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518113401",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380015701",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135075101",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380015702",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036508",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518299500",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693902",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044130",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098160",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267003912",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187093390",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518113400",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036509",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205051014",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693909",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080290",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056702",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084039665",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629177402",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098100",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335227003",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036507",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879402",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004253",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056703",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693903",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010014905",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004260",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335254602",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335176703",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367020305",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004270",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425057003",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693906",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518299501",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044112",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036502",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335227001",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752014214",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080260",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044160",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367020301",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205051030",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425057001",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060012",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335227004",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098155",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036500",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080212",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335227007",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098172",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036501",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080230",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060030",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098190",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036506",
      "ndc_label_name": "Butalbital-APAP-Caffeine TABLET 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056701",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080201",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335254603",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335263003",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335254604",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080220",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425057002",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004230",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060060",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080205",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420080210",
      "ndc_label_name": "Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238269301",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090583400",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512086008",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093542088",
      "ndc_label_name": "Cabergoline TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155082373",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090315700",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742011808",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090659600",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762100501",
      "ndc_label_name": "Cabergoline TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090764200",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069082408",
      "ndc_label_name": "Cabergoline Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42388002426",
      "ndc_label_name": "Cabometyx Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42388002446",
      "ndc_label_name": "Cabometyx Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42388002526",
      "ndc_label_name": "Cabometyx Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42388002546",
      "ndc_label_name": "Cabometyx Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42388002326",
      "ndc_label_name": "Cabometyx Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42388002336",
      "ndc_label_name": "Cabometyx Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42388002346",
      "ndc_label_name": "Cabometyx Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335029044",
      "ndc_label_name": "Caffeine Citrate Solution 60 MG/3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335029040",
      "ndc_label_name": "Caffeine Citrate Solution 60 MG/3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021060203",
      "ndc_label_name": "Caffeine Citrate SOLUTION 60 MG/3ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754050103",
      "ndc_label_name": "Caffeine Citrate SOLUTION 60 MG/3ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51754050303",
      "ndc_label_name": "Caffeine Citrate Solution 60 MG/3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485011010",
      "ndc_label_name": "Caffeine Citrate Solution 60 MG/3ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714076301",
      "ndc_label_name": "Calcipotriene Cream 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162216006",
      "ndc_label_name": "Calcipotriene Cream 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781711783",
      "ndc_label_name": "Calcipotriene Cream 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714076302",
      "ndc_label_name": "Calcipotriene Cream 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781711735",
      "ndc_label_name": "Calcipotriene Cream 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118997606",
      "ndc_label_name": "Calcipotriene CREAM 0.005 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407060512",
      "ndc_label_name": "Calcipotriene Cream 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407060560",
      "ndc_label_name": "Calcipotriene Cream 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993087761",
      "ndc_label_name": "Calcipotriene CREAM 0.005 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462050166",
      "ndc_label_name": "Calcipotriene CREAM 0.005 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993087778",
      "ndc_label_name": "Calcipotriene CREAM 0.005 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462050165",
      "ndc_label_name": "Calcipotriene CREAM 0.005 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462031066",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672415403",
      "ndc_label_name": "Calcipotriene OINTMENT 0.005 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993087861",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993087878",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672415404",
      "ndc_label_name": "Calcipotriene OINTMENT 0.005 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407060660",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407060612",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462031065",
      "ndc_label_name": "Calcipotriene Ointment 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383073202",
      "ndc_label_name": "Calcipotriene Solution 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168040060",
      "ndc_label_name": "Calcipotriene Solution 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713031853",
      "ndc_label_name": "Calcipotriene Solution 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884016111",
      "ndc_label_name": "Calcitonin (Salmon) SOLUTION 200 UNIT/ACT NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162212803",
      "ndc_label_name": "Calcitonin (Salmon) Solution 200 UNIT/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629215201",
      "ndc_label_name": "Calcitonin (Salmon) Solution 200 UNIT/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505082306",
      "ndc_label_name": "Calcitonin (Salmon) SOLUTION 200 UNIT/ACT NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090671100",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054000725",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155066201",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353003409",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054000713",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013830",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063381",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629874101",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756096788",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155066203",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013809",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063309",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093735201",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063330",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135061090",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452020713",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304023930",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747000",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407016901",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162103101",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353003430",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687034501",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452020720",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610052109",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353003481",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407016930",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629244501",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304023901",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099809",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756096783",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005830",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046809",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687034511",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380072304",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380072306",
      "ndc_label_name": "Calcitriol CAPSULE 0.25 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087030",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046830",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005801",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162192003",
      "ndc_label_name": "Calcitriol Capsule 0.25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155066301",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135061190",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380072406",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304024001",
      "ndc_label_name": "Calcitriol CAPSULE 0.5 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407017001",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093735301",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756096888",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452020820",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629874201",
      "ndc_label_name": "Calcitriol Capsule 0.5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904188260",
      "ndc_label_name": "Calcium + D3 Tablet 250-3 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917005037",
      "ndc_label_name": "Calcium 500 + D Tablet 500-3.125 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917005035",
      "ndc_label_name": "Calcium 500 + D Tablet 500-3.125 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007497",
      "ndc_label_name": "Calcium 500 + D Tablet 500-3.125 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864073099",
      "ndc_label_name": "Calcium 600 Tablet 1500 (600 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055694",
      "ndc_label_name": "Calcium 600 TABLET 1500 (600 Ca) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985027533",
      "ndc_label_name": "Calcium 600 Tablet 1500 (600 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985022257",
      "ndc_label_name": "Calcium 600 Tablet 1500 (600 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312004223",
      "ndc_label_name": "Calcium 600 Tablet 1500 (600 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985027532",
      "ndc_label_name": "Calcium 600 Tablet 1500 (600 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985027534",
      "ndc_label_name": "Calcium 600 Tablet 1500 (600 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896074606",
      "ndc_label_name": "Calcium 600 Tablet 1500 (600 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896074615",
      "ndc_label_name": "Calcium 600 Tablet 1500 (600 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94604049526",
      "ndc_label_name": "Calcium 600 Tablet 1500 (600 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917005023",
      "ndc_label_name": "Calcium 600 Tablet 600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917005027",
      "ndc_label_name": "Calcium 600 Tablet 600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917014592",
      "ndc_label_name": "Calcium 600+D Tablet 600-10 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917014682",
      "ndc_label_name": "Calcium 600+D Tablet 600-10 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917017081",
      "ndc_label_name": "Calcium 600+D Tablet 600-10 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007548",
      "ndc_label_name": "Calcium 600+D Tablet 600-10 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917009241",
      "ndc_label_name": "Calcium 600+D Tablet 600-10 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205082972",
      "ndc_label_name": "Calcium 600+D Tablet 600-10 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896074806",
      "ndc_label_name": "Calcium 600+D Tablet 600-10 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917008809",
      "ndc_label_name": "Calcium 600+D Tablet 600-10 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985022722",
      "ndc_label_name": "Calcium 600+D Tablet 600-10 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205039272",
      "ndc_label_name": "Calcium 600+D Tablet 600-10 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985022729",
      "ndc_label_name": "Calcium 600+D Tablet 600-10 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896074801",
      "ndc_label_name": "Calcium 600+D Tablet 600-10 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896074706",
      "ndc_label_name": "Calcium 600+D Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917005024",
      "ndc_label_name": "Calcium 600+D Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845014031",
      "ndc_label_name": "Calcium 600/Vitamin D Tablet Chewable 600-10 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00781208102",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904711961",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054008813",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571081320",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29033002602",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155053102",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904711906",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789042297",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291018920",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135062902",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054008826",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429049102",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097086283",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51293082502",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135019122",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096800",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096820",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856008802",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689079302",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094004461",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834032302",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367041102",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084047901",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096878",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096855",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282037702",
      "ndc_label_name": "Calcium Acetate (Phos Binder) CAPSULE 667 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73190003120",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180013415",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096860",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096830",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084047911",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518237200",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096872",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096864",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094004459",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804096890",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518272300",
      "ndc_label_name": "Calcium Acetate (Phos Binder) Capsule 667 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00536104922",
      "ndc_label_name": "Calcium Antacid Extra Strength Tablet Chewable 750 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536105022",
      "ndc_label_name": "Calcium Antacid Extra Strength Tablet Chewable 750 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536122922",
      "ndc_label_name": "Calcium Antacid Extra Strength Tablet Chewable 750 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "48433010701",
      "ndc_label_name": "Calcium Antacid Extra Strength Tablet Chewable 750 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "48433010601",
      "ndc_label_name": "Calcium Antacid TABLET CHEWABLE 500 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904641292",
      "ndc_label_name": "Calcium Antacid TABLET CHEWABLE 500 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090323000",
      "ndc_label_name": "Calcium Antacid Tablet Chewable 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864000150",
      "ndc_label_name": "Calcium Antacid Tablet Chewable 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63868005315",
      "ndc_label_name": "Calcium Antacid TABLET CHEWABLE 500 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70518041500",
      "ndc_label_name": "Calcium Antacid Tablet Chewable 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768003568",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 600-3.125 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312014230",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 600-3.125 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904585692",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00761081212",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904585652",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00761081232",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864000019",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00761081264",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "48107004925",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681013800",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54569595500",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090541700",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet 600-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090414200",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet Chewable 500-10 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090726200",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet Chewable 500-10 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681013700",
      "ndc_label_name": "Calcium Carb-Cholecalciferol Tablet Chewable 500-10 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70518226501",
      "ndc_label_name": "Calcium Carbonate Antacid Suspension 1250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70518324500",
      "ndc_label_name": "Calcium Carbonate Antacid Suspension 1250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904709894",
      "ndc_label_name": "Calcium Carbonate Antacid Suspension 1250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70518226500",
      "ndc_label_name": "Calcium Carbonate Antacid Suspension 1250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121476605",
      "ndc_label_name": "Calcium Carbonate Antacid Suspension 1250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121076616",
      "ndc_label_name": "Calcium Carbonate Antacid Suspension 1250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17856311730",
      "ndc_label_name": "Calcium Carbonate Antacid Suspension 1250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00054311763",
      "ndc_label_name": "Calcium Carbonate Antacid Suspension 1250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70518324501",
      "ndc_label_name": "Calcium Carbonate Antacid Suspension 1250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440722192",
      "ndc_label_name": "Calcium Carbonate Antacid Tablet 648 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610030130",
      "ndc_label_name": "Calcium Carbonate Antacid Tablet 648 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610030180",
      "ndc_label_name": "Calcium Carbonate Antacid Tablet 648 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536120610",
      "ndc_label_name": "Calcium Carbonate Antacid Tablet 648 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610030192",
      "ndc_label_name": "Calcium Carbonate Antacid Tablet 648 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440722194",
      "ndc_label_name": "Calcium Carbonate Antacid Tablet 648 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610030165",
      "ndc_label_name": "Calcium Carbonate Antacid Tablet 648 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610030153",
      "ndc_label_name": "Calcium Carbonate Antacid Tablet 648 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610030160",
      "ndc_label_name": "Calcium Carbonate Antacid Tablet 648 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610030185",
      "ndc_label_name": "Calcium Carbonate Antacid Tablet 648 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440721906",
      "ndc_label_name": "Calcium Carbonate Tablet 1250 (500 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917005021",
      "ndc_label_name": "Calcium Carbonate TABLET 1250 (500 Ca) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440721991",
      "ndc_label_name": "Calcium Carbonate Tablet 1250 (500 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917005034",
      "ndc_label_name": "Calcium Carbonate TABLET 1250 (500 Ca) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055565",
      "ndc_label_name": "Calcium Carbonate TABLET 1250 (500 Ca) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440721930",
      "ndc_label_name": "Calcium Carbonate Tablet 1250 (500 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440721960",
      "ndc_label_name": "Calcium Carbonate Tablet 1250 (500 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055581",
      "ndc_label_name": "Calcium Carbonate TABLET 1250 (500 Ca) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011329",
      "ndc_label_name": "Calcium Citrate + D Tablet 250-5 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40093010583",
      "ndc_label_name": "Calcium Citrate + D3 Tablet 315-6.25 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007538",
      "ndc_label_name": "Calcium Citrate Tablet 950 (200 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00761019520",
      "ndc_label_name": "Calcium Citrate Tablet 950 (200 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917005014",
      "ndc_label_name": "Calcium Citrate Tablet 950 (200 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681014000",
      "ndc_label_name": "Calcium Citrate Tablet 950 (200 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "35046000155",
      "ndc_label_name": "Calcium Citrate Tablet 950 (200 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985022318",
      "ndc_label_name": "Calcium Citrate Tablet 950 (200 Ca) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "07610015832",
      "ndc_label_name": "Calcium Citrate-Vitamin D Tablet 315-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917005016",
      "ndc_label_name": "Calcium Citrate-Vitamin D Tablet 315-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845012375",
      "ndc_label_name": "Calcium Citrate-Vitamin D Tablet 315-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629077402",
      "ndc_label_name": "Calcium Citrate-Vitamin D Tablet 315-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10006073037",
      "ndc_label_name": "Calcium Citrate-Vitamin D Tablet 315-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629077401",
      "ndc_label_name": "Calcium Citrate-Vitamin D Tablet 315-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604001475",
      "ndc_label_name": "Calcium Citrate-Vitamin D Tablet 315-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681011500",
      "ndc_label_name": "Calcium Citrate-Vitamin D Tablet 315-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10006070044",
      "ndc_label_name": "Calcium Citrate-Vitamin D Tablet 315-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681004500",
      "ndc_label_name": "Calcium Citrate-Vitamin D Tablet 315-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845012377",
      "ndc_label_name": "Calcium Citrate-Vitamin D Tablet 315-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917005015",
      "ndc_label_name": "Calcium Citrate-Vitamin D Tablet 315-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "07610093040",
      "ndc_label_name": "Calcium Oyster Shell TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629306503",
      "ndc_label_name": "Calcium-Magnesium-Zinc TABLET 333.33-133.33-5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768003568",
      "ndc_label_name": "Calcium-Vitamin D Tablet 600-3.125 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904188280",
      "ndc_label_name": "Calcium-Vitamin D3 Tablet 250-3.125 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11694097901",
      "ndc_label_name": "Calna Tablet Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00005550919",
      "ndc_label_name": "Caltrate 600+D3 Tablet 600-20 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00005550924",
      "ndc_label_name": "Caltrate 600+D3 Tablet 600-20 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00005550925",
      "ndc_label_name": "Caltrate 600+D3 Tablet 600-20 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00093614882",
      "ndc_label_name": "Camrese Lo TABLET 0.1-0.02 & 0.01 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093614891",
      "ndc_label_name": "Camrese Lo TABLET 0.1-0.02 & 0.01 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093313482",
      "ndc_label_name": "Camrese TABLET 0.15-0.03 &0.01 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093313491",
      "ndc_label_name": "Camrese TABLET 0.15-0.03 &0.01 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093747306",
      "ndc_label_name": "Capecitabine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407009560",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077460",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111049660",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054027121",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714046701",
      "ndc_label_name": "Capecitabine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729007212",
      "ndc_label_name": "Capecitabine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378251191",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756023886",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651020460",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980027606",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205000660",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407063960",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485020460",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001048706",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877045860",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162084306",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923072160",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756081560",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097094903",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001064306",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82249020760",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135078360",
      "ndc_label_name": "Capecitabine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714046801",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077560",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093747489",
      "ndc_label_name": "Capecitabine TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111049704",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407064012",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378251278",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268015411",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054027223",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729007329",
      "ndc_label_name": "Capecitabine TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687014911",
      "ndc_label_name": "Capecitabine TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268015413",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756023920",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687014994",
      "ndc_label_name": "Capecitabine TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079051005",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001064407",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722077512",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079051001",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980027712",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923072212",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485020512",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877045912",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651020508",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82249021012",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407009612",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135078412",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009011212",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097094808",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205000792",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001048807",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162084416",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756081622",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603030301",
      "ndc_label_name": "Capecitabine Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268019560",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536252525",
      "ndc_label_name": "Capsaicin CREAM 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50488102502",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49999040960",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70645002512",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959059503",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959025702",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959081502",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70645002550",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090229300",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50488102505",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50488102501",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959025703",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69420602505",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59088022008",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70645002525",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69420602501",
      "ndc_label_name": "Capsaicin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268019657",
      "ndc_label_name": "Capsaicin Cream 0.075 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45861007505",
      "ndc_label_name": "Capsaicin Cream 0.075 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "85231020260",
      "ndc_label_name": "Capsaicin Cream 0.075 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50488107501",
      "ndc_label_name": "Capsaicin Cream 0.075 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73141055802",
      "ndc_label_name": "Capsaicin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917009588",
      "ndc_label_name": "Capsaicin CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536126456",
      "ndc_label_name": "Capsaicin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268019842",
      "ndc_label_name": "Capsaicin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45861007404",
      "ndc_label_name": "Capsaicin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268019756",
      "ndc_label_name": "Capsaicin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50488106006",
      "ndc_label_name": "Capsaicin HP Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917006938",
      "ndc_label_name": "Capsaicin HP CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69375000660",
      "ndc_label_name": "Capsaicin HP Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51407060301",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781808001",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036610",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241016301",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657073801",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143117401",
      "ndc_label_name": "Captopril TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093810",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014401",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629873001",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093803",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292052850",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292052801",
      "ndc_label_name": "Captopril Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687030421",
      "ndc_label_name": "Captopril TABLET 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143117110",
      "ndc_label_name": "Captopril TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292052210",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723060",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781805201",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143117101",
      "ndc_label_name": "Captopril TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723092",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723094",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292052201",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657073501",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781805210",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723090",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241016001",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687030411",
      "ndc_label_name": "Captopril TABLET 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904710561",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241016010",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093503",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014101",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518330700",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036310",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73190002601",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093501",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407060001",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629872701",
      "ndc_label_name": "Captopril Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723130",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723191",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241016101",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723160",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093601",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143117201",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143117210",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407060110",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036410",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723192",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999010560",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723190",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999010500",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904710661",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781806101",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292052410",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090184003",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407060101",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241016110",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723194",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002043100",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014201",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999010510",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781806110",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289034430",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093603",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999010530",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629872801",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289034490",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002043130",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090429603",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629133801",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687031511",
      "ndc_label_name": "Captopril TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002043160",
      "ndc_label_name": "Captopril TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629133802",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657073601",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629133803",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687031521",
      "ndc_label_name": "Captopril TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292052401",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73190002701",
      "ndc_label_name": "Captopril Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723230",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999051160",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781807501",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723291",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723294",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723292",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241016201",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143117301",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723290",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629254104",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002108600",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014301",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781807510",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999051130",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289021290",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143117310",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036510",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629872901",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002108603",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407060201",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407060210",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723260",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292052601",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289021230",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093703",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241016210",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002108606",
      "ndc_label_name": "Captopril TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629254102",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093710",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292052610",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657073701",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73190002801",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629254103",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629254101",
      "ndc_label_name": "Captopril Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571082709",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 25-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571082809",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571082909",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 50-15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571083009",
      "ndc_label_name": "Captopril-hydroCHLOROthiazide Tablet 50-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335292101",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033001912",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017011",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505280507",
      "ndc_label_name": "CarBAMazepine ER CAPSULE EXTENDED RELEASE 12 HOUR 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162202102",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017013",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993040732",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672415101",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162202106",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993040832",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033002012",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904688504",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672415001",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518317601",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335270601",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017111",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017113",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629872101",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162171402",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335300201",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518317600",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505280607",
      "ndc_label_name": "CarBAMazepine ER CAPSULE EXTENDED RELEASE 12 HOUR 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672414901",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033000412",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017213",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335270701",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505280707",
      "ndc_label_name": "CarBAMazepine ER CAPSULE EXTENDED RELEASE 12 HOUR 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017211",
      "ndc_label_name": "CarBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162171502",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629872001",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993040932",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335300101",
      "ndc_label_name": "carBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135092760",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746078901",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668028401",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781801601",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571068001",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742025701",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714006301",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832602211",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518176900",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930007212",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806027401",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518176901",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382055501",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407089501",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518317401",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518176902",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672412301",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518317400",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518333501",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781598701",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407089601",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382055601",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571068101",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668028501",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832602311",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714006401",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518018101",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746079001",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930007312",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806027501",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518018102",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672412401",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742025801",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058311",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518018100",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058321",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135092860",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518265300",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518333500",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832602411",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742025901",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668028601",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781598801",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672412501",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746079101",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059421",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714006501",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135093060",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518154500",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806027601",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571068201",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930007412",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059411",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407089701",
      "ndc_label_name": "carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382055701",
      "ndc_label_name": "CarBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432012916",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094000859",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121094705",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121189410",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954024010",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094000862",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404709",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404704",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121094794",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135080224",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135080253",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135080245",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121189494",
      "ndc_label_name": "carBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094000762",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094000759",
      "ndc_label_name": "CarBAMazepine Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093010901",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723620",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999061600",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095353",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093010910",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723691",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723628",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904617261",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723690",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407021501",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090038400",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095380",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300038201",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904617250",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668026801",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668026805",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668026810",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400503",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090574003",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090216101",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063032830",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095360",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400501",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300038210",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999061601",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505018301",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721001",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090269700",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090216103",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090038403",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629871501",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063032812",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999061660",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629929601",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721002",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518224201",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016015",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090444300",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084044411",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095330",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090216100",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721008",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782503",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518245600",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505018300",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407021510",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002590",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090574000",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400502",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518090200",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518143600",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248906",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721006",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721003",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069101",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016011",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429003201",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069107",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518224202",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033630",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782509",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782501",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033660",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629875301",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452031220",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170801",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518224207",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267027891",
      "ndc_label_name": "CarBAMazepine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518224206",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782506",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834022100",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084044401",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518224205",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518224203",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518224208",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721009",
      "ndc_label_name": "CarBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610078280",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518224204",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248902",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452031232",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033680",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248900",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248904",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518284103",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834022101",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248901",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248905",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518314601",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518284100",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248903",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518314600",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518284101",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033653",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518284102",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189015730",
      "ndc_label_name": "carBAMazepine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723590",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723591",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429093405",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518242601",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687047901",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093077801",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687047911",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404102",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629929201",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668027101",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518242602",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518404201",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629874301",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440723528",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518143300",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999078201",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518242600",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904385461",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162257205",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404101",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668027105",
      "ndc_label_name": "CarBAMazepine TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518143301",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162257201",
      "ndc_label_name": "carBAMazepine Tablet Chewable 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228046010",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079097820",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228046001",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378008801",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729007817",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729007801",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084028101",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079097801",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032709",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001017100",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084028111",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756046188",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219203301",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771046001",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015530",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162219401",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015501",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079092301",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001017200",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228046110",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378009401",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729007901",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729007917",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756045788",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771046101",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079092320",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015630",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162219301",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544067260",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544067251",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228046101",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084028201",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219203401",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544067280",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015601",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084028211",
      "ndc_label_name": "Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722038105",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291047150",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093970101",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862007801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090718601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228253850",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090718600",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862007805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045705",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999099860",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093970105",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817039050",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862085505",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378007801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756051713",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 10-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087730",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817039010",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888010601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356062860",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68002010002",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651045601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722038101",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629235501",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087755",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367033801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046501",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046550",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367033805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087700",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291047101",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407016601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087772",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087711",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68002010004",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087760",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087764",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407016605",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087790",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087778",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862085501",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888010600",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756051788",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 10-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907002201",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888010605",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 10-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093970210",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722038205",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093970201",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904725761",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904623761",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353060460",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093970205",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722038201",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090658003",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291047210",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378008501",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904734761",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722038210",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090341901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904750161",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291047201",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090672700",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353060480",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090385701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046610",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090596903",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090596901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353051060",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090341902",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862007910",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739010810",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090749900",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353020260",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090658001",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090658002",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353051080",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090341903",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817039100",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518290900",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045810",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353020280",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090749802",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090672500",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079075601",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756051818",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087800",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407016701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090596902",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862007905",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090749803",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862085601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407016705",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756051888",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066480",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862007901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090749801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862085610",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009311",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817039110",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087872",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079075620",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817039150",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862085605",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651045705",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651045701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087860",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629235701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087878",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687066101",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009301",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687066111",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367033901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756051813",
      "ndc_label_name": "Carbidopa-Levodopa TABLET 25-100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064760",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518290901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087890",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367033910",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367033905",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629235601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057980",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518290902",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064780",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087830",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026980",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026960",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087811",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518325000",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888010701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066460",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907002001",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907002010",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057960",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888010700",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087855",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888010705",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087864",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907002005",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093970310",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045901",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228254010",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093970305",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228254050",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817039200",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999099960",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093970301",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291048810",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817039210",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904623861",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228254096",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722038305",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888010800",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862085810",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904754961",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407016805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367034001",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356062960",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378113301",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722038310",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907002101",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756051988",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046710",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367034005",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518290800",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046701",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722038301",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862085801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407016801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756098501",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651045801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087990",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862008001",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291048801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756051913",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651045805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817039250",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629235801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009401",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888010801",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087930",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228045905",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087960",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687083601",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087972",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087900",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888010805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687083611",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862085805",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756098502",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087911",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907002105",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629915401",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087955",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084009411",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087964",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087978",
      "ndc_label_name": "Carbidopa-Levodopa Tablet 25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335000188",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 12.5-50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571068901",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 12.5-50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679078204",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 12.5-50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781561301",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 12.5-50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332079531",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 12.5-50-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332079631",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 18.75-75-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571069001",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 18.75-75-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335000288",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 18.75-75-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781562501",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 18.75-75-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679078304",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 18.75-75-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571069101",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679078404",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378830201",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335000388",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332079731",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781563701",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335000488",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332079831",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571069201",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781564101",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679078504",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781565401",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 37.5-150-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335000588",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 37.5-150-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679078604",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 37.5-150-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571069301",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 37.5-150-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332079931",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 37.5-150-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571069401",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332080031",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378830501",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335000688",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781566901",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679078704",
      "ndc_label_name": "Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991033404",
      "ndc_label_name": "Carbinoxamine Maleate Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64950024304",
      "ndc_label_name": "Carbinoxamine Maleate Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64950024316",
      "ndc_label_name": "Carbinoxamine Maleate Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64950021101",
      "ndc_label_name": "Carbinoxamine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44523082501",
      "ndc_label_name": "Carbinoxamine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991033301",
      "ndc_label_name": "Carbinoxamine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70393000114",
      "ndc_label_name": "CareTouch 2 CPAP Hose Hanger",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70393000109",
      "ndc_label_name": "CareTouch CPAP & BIPAP Hose",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70393040170",
      "ndc_label_name": "CareTouch CPAP Mask Wipes",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70393040271",
      "ndc_label_name": "CareTouch CPAP Mask Wipes",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70393000190",
      "ndc_label_name": "CareTouch CPAP Pre-Wash Soln",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70393040102",
      "ndc_label_name": "CareTouch CPAP Tube Brush",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70393000131",
      "ndc_label_name": "CareTouch Universl CPAP Filter",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61314023810",
      "ndc_label_name": "Carteolol HCl SOLUTION 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61314023805",
      "ndc_label_name": "Carteolol HCl SOLUTION 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61314023815",
      "ndc_label_name": "Carteolol HCl SOLUTION 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378363301",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135063501",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093729501",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135063505",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255503",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353016070",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378363305",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093729505",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904730761",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063012593",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063012590",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255500",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629366901",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090106701",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781522301",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904630261",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207900",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353016060",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353016053",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079093120",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629366902",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255502",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353016080",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353016030",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004101",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087480",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087430",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629366903",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788753906",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687800",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090106703",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090106700",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111025401",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207901",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087460",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001015100",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788753909",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001015103",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090106704",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462016401",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760049460",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207903",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255501",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009401",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789053793",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788815103",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079093101",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788753901",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862014401",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207904",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255504",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788815101",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003605",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788815109",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760023460",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009012705",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888050102",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004105",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919072890",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518035600",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385011250",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111025405",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919072830",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518035601",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187044790",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187044730",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462016405",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934070730",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862014405",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788753903",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934070790",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006660",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009405",
      "ndc_label_name": "Carvedilol TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934051590",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006680",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804022590",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645035159",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189037230",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788815106",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003601",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934051530",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003600",
      "ndc_label_name": "Carvedilol Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378363401",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093729605",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093729601",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083260",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356052600",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135063705",
      "ndc_label_name": "Carvedilol TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904630361",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090106904",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781522401",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378363405",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090106900",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090489800",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063012993",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013330",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135063701",
      "ndc_label_name": "Carvedilol TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079093220",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356052690",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904730861",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090106901",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784903",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090211904",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784900",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063012960",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001015200",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013380",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063012930",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090417101",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004205",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090572600",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645049659",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013353",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681908",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090106903",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013360",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111025505",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053390",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004201",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681901",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083209",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791009",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090211900",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090211903",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760023560",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862014501",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111025501",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788823109",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083280",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789044093",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090417100",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090417103",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919073060",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462016501",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154567600",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518182602",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090211901",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385011301",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079093201",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090417104",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919073090",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788823101",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919073030",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934065330",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784901",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804018390",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001015203",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518182600",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187040930",
      "ndc_label_name": "Carvedilol TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006780",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862014505",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003700",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784904",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003705",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681903",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934040630",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934075990",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888050202",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009501",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006760",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090785000",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009012805",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681909",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187040960",
      "ndc_label_name": "Carvedilol TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462016505",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071085630",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791003",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009505",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003701",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681906",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518182601",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791001",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385011350",
      "ndc_label_name": "Carvedilol TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791006",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518238900",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789044090",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013860",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888050201",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013890",
      "ndc_label_name": "Carvedilol Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063012693",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093005105",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083780",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378363105",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083760",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781522101",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378363101",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093005101",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090185601",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904730561",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090206600",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904630061",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090206602",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135063301",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063012660",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090106201",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079077101",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090106200",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462016201",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090185603",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919021990",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135063305",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083753",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090206603",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407003905",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090106202",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745806",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079077120",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862014205",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013253",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407003901",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090694900",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111025201",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090106203",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825206",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111025205",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001015300",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090185600",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009201",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745803",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862014201",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187057090",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825209",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745801",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001015303",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090206601",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518137702",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825203",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462016205",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187094160",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009012505",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518137704",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825201",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919021930",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006253",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825208",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518137700",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009205",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518137701",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013260",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518137703",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745808",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006260",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013280",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013253",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006280",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789041190",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003400",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745809",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888049901",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003401",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888049902",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518058201",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385011050",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804019160",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189065390",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003405",
      "ndc_label_name": "Carvedilol Tablet 3.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385011001",
      "ndc_label_name": "Carvedilol TABLET 3.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085411",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904630161",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135063405",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378363205",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093013501",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781522201",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093013505",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378363201",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009305",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356051218",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353015660",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063083360",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135063401",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904730661",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353015680",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083860",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006353",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353015653",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083830",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083880",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217504",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090686500",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217500",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674204",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003501",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674200",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083853",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090106401",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674201",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079093001",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217501",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760023360",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385011101",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111025301",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674203",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217503",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079093020",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004005",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004001",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919098430",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111025305",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919098490",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187042430",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081918",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760058260",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760053260",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081990",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862014305",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187094690",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187094660",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629366803",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629366801",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629366802",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462016305",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037660",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681701",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681706",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071084130",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001015400",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862014301",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788303",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681703",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462016301",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788301",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009012605",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645035059",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001015403",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085401",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934068660",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681708",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009301",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817706",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760303",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760301",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788309",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760308",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518042600",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681709",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003505",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006380",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760306",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788308",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760309",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789043160",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788306",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518042604",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817709",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888050001",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817703",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888050002",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006360",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385011150",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788978903",
      "ndc_label_name": "Carvedilol TABLET 6.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003500",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518042601",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518042603",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934051760",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006330",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189066460",
      "ndc_label_name": "Carvedilol Tablet 6.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714038901",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237009701",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008301",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180018102",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039002",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008475",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180018202",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180018203",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237009801",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039001",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862008401",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237009875",
      "ndc_label_name": "Cefadroxil SUSPENSION RECONSTITUTED 500 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781217660",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090271900",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063095914",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093316006",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714039102",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904756304",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714039101",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291004360",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063095920",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090271903",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090103102",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090103101",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090103103",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356003820",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096414",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090263600",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090604201",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084020",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090103300",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090103200",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090103302",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090604101",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090103303",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090271902",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001036206",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629367101",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090103301",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687069911",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629367105",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090604102",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090271901",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090604103",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798702",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180071160",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237009960",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629367103",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862017760",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090604100",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090604200",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205057614",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733902",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518253700",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760602",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832302",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687069921",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629367104",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084014",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005414",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042320",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840402",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205057620",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098920",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022414",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629367102",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789006120",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189030820",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006220",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789055010",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629896801",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042314",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004420",
      "ndc_label_name": "Cefdinir CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877054360",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934016420",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189030814",
      "ndc_label_name": "Cefdinir Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093413673",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781607746",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862021860",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093413664",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781607761",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039201",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187083500",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090425800",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090792900",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862021801",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090641700",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039202",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072205",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189018532",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054788",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356011960",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054798",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189004232",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072204",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093413773",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781607861",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093413764",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039302",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090581100",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090372300",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090617100",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781607846",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090372500",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039301",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356019000",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187061600",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072304",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862021901",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189018632",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090102700",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180072305",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090273500",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054888",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862021960",
      "ndc_label_name": "Cefdinir SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788784401",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788865501",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090102800",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090558300",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054898",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205040560",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205038000",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788706201",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205040500",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189025932",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205038060",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189004332",
      "ndc_label_name": "Cefdinir Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862009975",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039601",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003450",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304096001",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862009901",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304096003",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039602",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003475",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040103",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039603",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040102",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040101",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003401",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304096101",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039702",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090322600",
      "ndc_label_name": "Cefprozil Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039701",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003501",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010075",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003550",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714039703",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862010001",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040202",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040201",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237003575",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180040203",
      "ndc_label_name": "Cefprozil SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904754210",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090699900",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714040002",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714040001",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440724503",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063058420",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063062314",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440724504",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090699901",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237005820",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090215900",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002027520",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065760",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090215803",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090078100",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065614",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090709503",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090766700",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090709500",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429065620",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090215800",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099120",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090078103",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065720",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429065660",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180030260",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090766701",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092101",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407033360",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090215901",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090078201",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862069920",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014520",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687027294",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407033320",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629944701",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092102",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862069960",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237005860",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074720",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687027211",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629944601",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004420",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877021520",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877021560",
      "ndc_label_name": "Cefuroxime Axetil TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180030220",
      "ndc_label_name": "Cefuroxime Axetil Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090215700",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714040101",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090766800",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002026720",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407033460",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090766801",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714040102",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862070060",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237005960",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934008820",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407033420",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092201",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429065720",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959093920",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090415300",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862070020",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629944801",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425057101",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959093930",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877021660",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687028311",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425057102",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237005920",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092202",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877021620",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687028394",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429065760",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180030360",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180030320",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518269400",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629356201",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788890502",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518321500",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629356202",
      "ndc_label_name": "Cefuroxime Axetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003514",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629944901",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003520",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003560",
      "ndc_label_name": "Cefuroxime Axetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093716505",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378716001",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015615",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788011301",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808029602",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093716501",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904650261",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668044101",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591398301",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668044105",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072105",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073201",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079019920",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378716005",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788011305",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015611",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043601",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808029601",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700061360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571014301",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762151603",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591398305",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571014305",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638001",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004530",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228015701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043611",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700061330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429046005",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073202",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436398301",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228015705",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728606",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016811",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505384801",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505384805",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072101",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016815",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820603",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436398201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919068260",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760064930",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638000",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014131",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079019901",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097042207",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429046001",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135002160",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760099515",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760099560",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436790101",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002060",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097042212",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043665",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180039601",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014171",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728609",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762151601",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335029201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187030160",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518292200",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760099530",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180039602",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367030105",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820609",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760020960",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180404",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187064360",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205043960",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004560",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69399018381",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180405",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002102",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760064960",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030205",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862090805",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335029203",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862090801",
      "ndc_label_name": "Celecoxib CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518274800",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335222203",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335201901",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739029710",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084307",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518292201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180403",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002103",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335093605",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012372",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728603",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014202",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335093601",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335222201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205043930",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024307",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012390",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820606",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335093604",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834023705",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241002305",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084320",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024301",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367030101",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301001101",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072730",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072714",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084390",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024390",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335093603",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771015701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241002310",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072790",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072720",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032303",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072705",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771015705",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335093606",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009006805",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834023701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008007560",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072760",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008007530",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072707",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032101",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180401",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804015160",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509123701",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084300",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084301",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335201903",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072710",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084310",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288002130",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335222204",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084360",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014201",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016702",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030230",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032302",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032102",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509123709",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162225405",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032103",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189066272",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032301",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084305",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288002120",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084314",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301001102",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084330",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509123703",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509123706",
      "ndc_label_name": "Celecoxib Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093716601",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093716605",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788011405",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591398401",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378715005",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808029702",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904650361",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378715001",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591398405",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668044205",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015711",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808029701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242700",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066930",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668044201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788011401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066960",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073302",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066920",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571014405",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090657701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073301",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015715",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082510",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072205",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066910",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228015805",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090657702",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571014401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082530",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082514",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090478900",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096714",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016911",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675802",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090478901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082560",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353003630",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517800",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025753",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436014401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436014402",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066914",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090478902",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563800",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318301",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436398402",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436398401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675800",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318302",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082430",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036015",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090657700",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090707200",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318300",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760074215",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079021520",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563802",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082460",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135002201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675900",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436384902",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517802",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082415",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762151701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228015801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919016860",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014231",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016915",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060714",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083710",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760074230",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436384901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187056260",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862090901",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079021501",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762151703",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429046105",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036030",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436770101",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187063330",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180039901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687044711",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505384905",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687044701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135002260",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036042",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436770102",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629550303",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726406",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919016830",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036010",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760074260",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014271",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036060",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429046101",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862090905",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014291",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187056230",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867909",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083790",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505384901",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726409",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819703",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629550304",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629550301",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083742",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518329201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629550302",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367030201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819706",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773501",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739029810",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187063360",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518417501",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773508",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036090",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867903",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819709",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726403",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773509",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205005560",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69399018481",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819708",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241002410",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677015415",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002202",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773503",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867908",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335086802",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934002614",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097042107",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025960",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518134600",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367030205",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773506",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677015460",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335106602",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162238005",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097042112",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420071420",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518134601",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69680013500",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867906",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677015490",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028330",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420071414",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002203",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084405",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002714",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518134602",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69399018485",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518320400",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162235705",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084400",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69399019485",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084414",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002730",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518329200",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677015401",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518373301",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242105",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084412",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518329202",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009601",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205066430",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335086801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677015430",
      "ndc_label_name": "Celecoxib CAPSULE 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518373302",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162248905",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003701",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518373303",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020902",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205066490",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335222002",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335106601",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002760",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834023801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009603",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002790",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038203",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335106606",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335245601",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335222001",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205066414",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420000901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205005530",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804021360",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420071430",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058453",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028353",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205066460",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420000930",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030330",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335245604",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335106603",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084407",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162217505",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028360",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335245602",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420000960",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162217506",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030305",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162217503",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084420",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036042",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058430",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162238001",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420071405",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025930",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036030",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242101",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084460",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834023805",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058460",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162248901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084490",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420071460",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241002405",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036010",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003702",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420071490",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030301",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420071401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288002220",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025914",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084410",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009602",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771015801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036060",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003902",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020903",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288002230",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420071407",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001330",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028102",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001360",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420000907",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301001201",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804021314",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301001202",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771015805",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509115801",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420071410",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003802",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084401",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004002",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084430",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028103",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028104",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004001",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804021330",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020901",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804021390",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020904",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028101",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038202",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009006905",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509115803",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509115806",
      "ndc_label_name": "Celecoxib Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093717006",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072360",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031005",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031060",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668031001",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591398560",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788011560",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135002360",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378717091",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69399018581",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014360",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180039807",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015809",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073401",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571014560",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862091060",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072890",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288002360",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072814",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002302",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228015960",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429046260",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762151802",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097042003",
      "ndc_label_name": "Celecoxib CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084520",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002301",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084514",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834023960",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241002503",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072801",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002303",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084501",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084560",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072807",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072860",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084505",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072820",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084530",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084590",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084507",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072830",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771015960",
      "ndc_label_name": "Celecoxib Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571014260",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808029501",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228015660",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591398260",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093730606",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714073101",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788011260",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015509",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834023660",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429045960",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668030760",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072607",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378716591",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072060",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505384706",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762151501",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072601",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862090760",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030101",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072614",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097042303",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014060",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030130",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084201",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301002801",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180039507",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69399018281",
      "ndc_label_name": "Celecoxib CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084230",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71626030160",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002001",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084200",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084207",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084214",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241002203",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084260",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771015660",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072620",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072660",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072630",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084220",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420072690",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084290",
      "ndc_label_name": "Celecoxib Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00005423720",
      "ndc_label_name": "Centrum Kids Tablet Chewable Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00005180623",
      "ndc_label_name": "Centrum Specialist Prenatal 27-0.8 & 200 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00005436556",
      "ndc_label_name": "Centrum Specialist Prenatal 27-0.8 & 200 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "42582021118",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440724328",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093314501",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049720",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049704",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049728",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093314505",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291020850",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049710",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582021110",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049706",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999004120",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090329101",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049740",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440724340",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049708",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999004130",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049730",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049709",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007002",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003024",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999004104",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904733661",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063067828",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007202",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320202",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049715",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268015111",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687015211",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007100",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634043371",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999004110",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007205",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320205",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007203",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348056028",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001801",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007204",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999004112",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320203",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007208",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320208",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090329100",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756029313",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518227301",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629426701",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999004128",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003020",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007300",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003012",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268015115",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629422201",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003040",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629919901",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320204",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003056",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629885501",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003030",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003028",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788971302",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267004912",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001805",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003001",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687015201",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788971307",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005030",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289005730",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135071074",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788971308",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001840",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003008",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584023501",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934084020",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629426801",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898001",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756029388",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335286401",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788971303",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289005720",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629425701",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162183105",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788971306",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877022001",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180012101",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420075428",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788971304",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629885401",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180012102",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877022005",
      "ndc_label_name": "Cephalexin CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934008230",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629919801",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518227300",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788971300",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420075430",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003440",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518425000",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934008294",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162183101",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934010840",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162183102",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025201",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420075440",
      "ndc_label_name": "Cephalexin Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440724440",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634043440",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904733761",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093314705",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634043471",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291020950",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007906",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093314701",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634043480",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063053604",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063053608",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440124440",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063053610",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999000710",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305707",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440724430",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582021218",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063053614",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063053621",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582021210",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999000712",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999000760",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090342703",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904733706",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063053609",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063053640",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999000721",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063053606",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999000715",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007907",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090442201",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063053630",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063053620",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999000790",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090008001",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063053628",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007902",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090702700",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090594802",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063053656",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063428",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007900",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090008003",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999000700",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007905",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268015211",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090594807",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305200",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325201",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007901",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090267700",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007908",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090008101",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436011701",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436102002",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305708",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268015215",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090007903",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090274900",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090008100",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305700",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436011708",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436221002",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090342701",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436011704",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305702",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305705",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090274901",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305703",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436102005",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436221004",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090594800",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436102004",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090311101",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319905",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305701",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305706",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003100",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003121",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090594803",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003104",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319902",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325200",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319900",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319906",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003106",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003156",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090722400",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003110",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319903",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090442207",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319901",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319907",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003120",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021828",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436011703",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003124",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319908",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003114",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090442208",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090442202",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348055540",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348055520",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436221005",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003130",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090442200",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003140",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090702603",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090442205",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289005840",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289005820",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003108",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003160",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090442203",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021814",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090722300",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090594801",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002910",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118029403",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003128",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021810",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090442206",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003514",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436011702",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090594808",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052228",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118029404",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687016301",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021820",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090594805",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003528",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436011705",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090716201",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060640",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003530",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005120",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021821",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090702601",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135071174",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655072051",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003112",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060656",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919041030",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052220",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289005830",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436102001",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584023601",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003102",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289005814",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629422001",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060614",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052230",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118029402",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436221001",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756029413",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003115",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118029407",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898101",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187004606",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187004614",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002930",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021830",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756029488",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021840",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002928",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001905",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187004615",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629423001",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005130",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348055514",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187004640",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002920",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003520",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267005005",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187004628",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629425901",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035828",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348055528",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629574001",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002940",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060610",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877021984",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629574201",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629427001",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919041010",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289005828",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180012202",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052210",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62250080208",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776104",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629774201",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629574101",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187004620",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687016311",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776101",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060628",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629421901",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788932607",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629920101",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267005010",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187004630",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003510",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776107",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629920001",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629422101",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788975204",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001940",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267005015",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629774001",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003540",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853803",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071202408",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629760501",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305902",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776103",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267055928",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629774301",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052240",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874009",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180012201",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629885601",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004010",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788932600",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776102",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877021901",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060620",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788932608",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776108",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877021905",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025182",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788932603",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853801",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071435502",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060630",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788932609",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874005",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853806",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420073620",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004056",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874003",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071435507",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629426901",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305904",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874008",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853808",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000402",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006530",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788975207",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776105",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001901",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305905",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305903",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853809",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000404",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006540",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518336200",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776106",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267005006",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004030",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305908",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874001",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000407",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006594",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518344804",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853802",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853804",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004094",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305909",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874004",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012101",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268501",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420073614",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788932602",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853805",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067220",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004040",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874006",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012104",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162214505",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420073628",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788975202",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853807",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162183001",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006520",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788932604",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012106",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003540",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804010620",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788975203",
      "ndc_label_name": "Cephalexin CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874002",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083110",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067230",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305907",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874007",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420073600",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420073640",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305900",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518306601",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083140",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083130",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518306600",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518306602",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000501",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083142",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305901",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518385703",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000405",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000401",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934010910",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004020",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000502",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000406",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305906",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004021",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012103",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000601",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067215",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934010928",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012105",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000602",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518337800",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067214",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804010628",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804010630",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067228",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067240",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205059106",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804010640",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162183005",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162183002",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420073621",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420073601",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000403",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420073630",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012102",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000503",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012107",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804010614",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804010615",
      "ndc_label_name": "Cephalexin Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629920501",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162185002",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959020001",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093417573",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093417574",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979015438",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979015414",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959020002",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054488",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999071300",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135048049",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779601",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054468",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135048042",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180044001",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629920401",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162185001",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788779602",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180044002",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959062001",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093417773",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979015538",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090022000",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999026120",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629885701",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090479500",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979015514",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118997302",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093417774",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090519600",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959062000",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090021900",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180044101",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090709100",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090644500",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054568",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335287701",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629920601",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919079832",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919004932",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205055300",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629920701",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629885801",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054588",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335273401",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162185102",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135048149",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135048142",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162185104",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788793801",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788793802",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180044102",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267098200",
      "ndc_label_name": "Cephalexin SUSPENSION RECONSTITUTED 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335298601",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868602",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162185101",
      "ndc_label_name": "Cephalexin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094000459",
      "ndc_label_name": "Cetirizine HCl Childrens SOLUTION 5 MG/5ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094000462",
      "ndc_label_name": "Cetirizine HCl Childrens SOLUTION 5 MG/5ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00781168301",
      "ndc_label_name": "Cetirizine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16571040110",
      "ndc_label_name": "Cetirizine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00378363501",
      "ndc_label_name": "Cetirizine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55700033130",
      "ndc_label_name": "Cetirizine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205009330",
      "ndc_label_name": "Cetirizine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536127935",
      "ndc_label_name": "Cetirizine-Pseudoephedrine ER Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536127912",
      "ndc_label_name": "Cetirizine-Pseudoephedrine ER Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802014753",
      "ndc_label_name": "Cetirizine-Pseudoephedrine ER Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187095524",
      "ndc_label_name": "Cetirizine-Pseudoephedrine ER Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090109801",
      "ndc_label_name": "Cetirizine-Pseudoephedrine ER Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802014762",
      "ndc_label_name": "Cetirizine-Pseudoephedrine ER Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090253701",
      "ndc_label_name": "Cetirizine-Pseudoephedrine ER Tablet Extended Release 12 Hour 5-120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49614044871",
      "ndc_label_name": "Chest Congestion Relief Tablet 400 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000045202",
      "ndc_label_name": "Chest Congestion Relief Tablet 400 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000005501",
      "ndc_label_name": "Chest Congestion Relief Tablet 400 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536131108",
      "ndc_label_name": "Chest Congestion Relief Tablet 400 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10956079450",
      "ndc_label_name": "Chest Congestion Relief TABLET 400 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800079450",
      "ndc_label_name": "Chest Congestion Relief Tablet 400 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681011600",
      "ndc_label_name": "Childrens Chew Multivitamin Tablet Chewable Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49614037626",
      "ndc_label_name": "Childrens Cold & Allergy Elixir 1-2.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30142090626",
      "ndc_label_name": "Childrens Cold & Allergy Elixir 1-2.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800041926",
      "ndc_label_name": "Childrens Mucus Relief Cough Liquid 5-100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65504027289",
      "ndc_label_name": "Childrens Non-Aspirin TABLET CHEWABLE 80 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363018601",
      "ndc_label_name": "Childrens Non-Aspirin TABLET CHEWABLE 80 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363031801",
      "ndc_label_name": "Childrens Non-Aspirin TABLET CHEWABLE 80 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363059608",
      "ndc_label_name": "Childrens Soothe TABLET CHEWABLE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007604",
      "ndc_label_name": "Childrens Soothe TABLET CHEWABLE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113003426",
      "ndc_label_name": "Childs Cold/Allergy ELIXIR 1-15 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00085083503",
      "ndc_label_name": "Chlor-Trimeton Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "42806056201",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440725190",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096953",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555003302",
      "ndc_label_name": "ChlordiazePOXIDE HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079037501",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555003305",
      "ndc_label_name": "ChlordiazePOXIDE HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440725160",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069830",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069860",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440725191",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806056501",
      "ndc_label_name": "ChlordiazePOXIDE HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079037520",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518175201",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071073460",
      "ndc_label_name": "ChlordiazePOXIDE HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518175200",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069853",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135022160",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440725215",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440725212",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555015902",
      "ndc_label_name": "ChlordiazePOXIDE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440725206",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440725208",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440725230",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440725290",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440725291",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806056601",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555015904",
      "ndc_label_name": "ChlordiazePOXIDE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069953",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687080711",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806056301",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069930",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079014101",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004603",
      "ndc_label_name": "ChlordiazePOXIDE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004615",
      "ndc_label_name": "ChlordiazePOXIDE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919059330",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518001500",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004606",
      "ndc_label_name": "ChlordiazePOXIDE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004612",
      "ndc_label_name": "ChlordiazePOXIDE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069960",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004625",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004619",
      "ndc_label_name": "ChlordiazePOXIDE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004624",
      "ndc_label_name": "ChlordiazePOXIDE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629402702",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079014120",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999024410",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088730",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999024420",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518001501",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999024430",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026353",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629402701",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687080701",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135022260",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135022060",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440725030",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806056401",
      "ndc_label_name": "ChlordiazePOXIDE HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555015804",
      "ndc_label_name": "ChlordiazePOXIDE HCl CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629372502",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555015802",
      "ndc_label_name": "ChlordiazePOXIDE HCl CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518313400",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079037401",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079037420",
      "ndc_label_name": "chlordiazePOXIDE HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00116200104",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00116200107",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00116200116",
      "ndc_label_name": "Chlorhexidine Gluconate SOLUTION 0.12 % MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00116200115",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904703587",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00116200106",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135065024",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904703580",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089316",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089340",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121089300",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571012815",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856200103",
      "ndc_label_name": "Chlorhexidine Gluconate SOLUTION 0.12 % MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571012848",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70166002603",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687071464",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689010699",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69339013817",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571012852",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687071416",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69339013815",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856200203",
      "ndc_label_name": "Chlorhexidine Gluconate SOLUTION 0.12 % MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856200105",
      "ndc_label_name": "Chlorhexidine Gluconate SOLUTION 0.12 % MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135064941",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090072200",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135064947",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687061616",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788817304",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687061664",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739005257",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135065051",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69339013819",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689010601",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739005269",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033051215",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689010650",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033051250",
      "ndc_label_name": "Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440725314",
      "ndc_label_name": "Chloroquine Phosphate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115279006",
      "ndc_label_name": "Chloroquine Phosphate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440725304",
      "ndc_label_name": "Chloroquine Phosphate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980017750",
      "ndc_label_name": "Chloroquine Phosphate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385014205",
      "ndc_label_name": "Chloroquine Phosphate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115701009",
      "ndc_label_name": "Chloroquine Phosphate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135071726",
      "ndc_label_name": "Chloroquine Phosphate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440725404",
      "ndc_label_name": "Chloroquine Phosphate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155085074",
      "ndc_label_name": "Chloroquine Phosphate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980017802",
      "ndc_label_name": "Chloroquine Phosphate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291004725",
      "ndc_label_name": "Chloroquine Phosphate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702001724",
      "ndc_label_name": "Chlorpheniramine Maleate ER Tablet Extended Release 12 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10702001706",
      "ndc_label_name": "Chlorpheniramine Maleate ER Tablet Extended Release 12 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440727912",
      "ndc_label_name": "Chlorpheniramine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440727924",
      "ndc_label_name": "Chlorpheniramine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440727910",
      "ndc_label_name": "Chlorpheniramine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440727930",
      "ndc_label_name": "Chlorpheniramine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289056001",
      "ndc_label_name": "Chlorpheniramine Maleate TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289056024",
      "ndc_label_name": "Chlorpheniramine Maleate TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090276507",
      "ndc_label_name": "Chlorpheniramine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440727905",
      "ndc_label_name": "Chlorpheniramine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440727916",
      "ndc_label_name": "Chlorpheniramine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090276506",
      "ndc_label_name": "Chlorpheniramine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61919040230",
      "ndc_label_name": "Chlorpheniramine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54738010301",
      "ndc_label_name": "Chlorpheniramine Maleate TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69618002210",
      "ndc_label_name": "Chlorpheniramine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61919040271",
      "ndc_label_name": "Chlorpheniramine Maleate TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69618002201",
      "ndc_label_name": "Chlorpheniramine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54738010303",
      "ndc_label_name": "Chlorpheniramine Maleate TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789013424",
      "ndc_label_name": "Chlorpheniramine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518296100",
      "ndc_label_name": "Chlorpheniramine Maleate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00781591301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030000",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238105401",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527296137",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687041901",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832601700",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332073531",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714004701",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904712961",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904689261",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135042090",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016211",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155080301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407043401",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462086101",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016215",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710112901",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304018501",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687041911",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "90096013101",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728630",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030310",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728690",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781591601",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687045201",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155080601",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832602010",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030389",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832602001",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356009890",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527296437",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135042390",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238106001",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090602900",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904713261",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832602089",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090286500",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687045211",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527296443",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462086401",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714005001",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016515",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030300",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016511",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332073831",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407043701",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832602000",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304011410",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205010691",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710113201",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304011401",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "90096013401",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527296543",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714005101",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030400",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687046301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030489",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016612",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527296537",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832602101",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781591701",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "90096013501",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030410",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832602110",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030401",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407043801",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332073931",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687046311",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904713361",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304008301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832602100",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135042490",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304008310",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462086501",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832602189",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238106201",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155080701",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710113301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016611",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205010791",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030101",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527296243",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527296237",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030100",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030189",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407043501",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016311",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781591401",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832601800",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135042190",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043065",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518303400",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904713061",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043011",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332073631",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030110",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904713006",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304014310",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304014301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832601810",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016315",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462086201",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518317500",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714004801",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155080401",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518160800",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "90096013201",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090279100",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043001",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238105601",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710113001",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090596500",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518308600",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205010491",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728590",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462086301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904713161",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728530",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527296337",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030201",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030210",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016411",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832601901",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832601910",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714004901",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527296343",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781591501",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687044101",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155080501",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135042290",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832601989",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304012201",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238105801",
      "ndc_label_name": "ChlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030289",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832030200",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518334800",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518328000",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304012210",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407043601",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710113101",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "90096013301",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832601900",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016415",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518001600",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332073731",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687044111",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518332100",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205010591",
      "ndc_label_name": "chlorproMAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378022210",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904690061",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014401",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378022201",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598017001",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904690004",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598071901",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319002",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241021601",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405303",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016715",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080001",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598017010",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904758361",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319001",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090612601",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079005801",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407703",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079005820",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300033301",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014402",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714012801",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090564302",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090695702",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687031701",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407709",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224001870",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598071910",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090564301",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090612602",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746076036",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090783100",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135050590",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068216",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934047030",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999065030",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090695701",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224001850",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687031725",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268016711",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405309",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068260",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335293501",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756001111",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090695800",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687031711",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980059901",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289006730",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035660",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035830",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002909",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213300",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687031795",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332067631",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162024709",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064888",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834010910",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629848001",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002945",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834010901",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135050530",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980030310",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382097010",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746076001",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980030301",
      "ndc_label_name": "Chlorthalidone TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980059910",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047230",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629876101",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877069601",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382097001",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788829409",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002916",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877069610",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002930",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047245",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213303",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002960",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189050760",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756001112",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189064460",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068230",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047260",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068245",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002980",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213301",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213306",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035890",
      "ndc_label_name": "Chlorthalidone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598016701",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598072001",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746076101",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353092209",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241021701",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378021310",
      "ndc_label_name": "Chlorthalidone TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378021301",
      "ndc_label_name": "Chlorthalidone TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664064988",
      "ndc_label_name": "Chlorthalidone TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629876201",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598072010",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629929801",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316101",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598016710",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714012901",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090586001",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332067731",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014501",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700058630",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382097101",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162201002",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518301",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714080101",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980060001",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213401",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135050630",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980030401",
      "ndc_label_name": "Chlorthalidone TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162025009",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213406",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135050690",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300033401",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756002011",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756002012",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877069701",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224011850",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335295601",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002109",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213403",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629246501",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035990",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162201001",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035930",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834011001",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834011010",
      "ndc_label_name": "Chlorthalidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440727020",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24470094050",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440727030",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571072601",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440727010",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090031504",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440727028",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440727040",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591252005",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002057630",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591252001",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289063328",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090031500",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090668900",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24470094010",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999004460",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090668903",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002057640",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289063324",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919047830",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090750403",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090750400",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090031501",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090031503",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289063320",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760047990",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267005500",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267005591",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090750404",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002057610",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090031600",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090668901",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289063330",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919047890",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031501",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050703",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002057615",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289063340",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002057620",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090668904",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760061990",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267005530",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700095130",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090750401",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289063310",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700095160",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205071130",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760047940",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187031730",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335191402",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031502",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760057840",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700095190",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651030605",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267005520",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518049602",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651030601",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335191405",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335243305",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335191404",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760057890",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919047840",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73007001303",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050702",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518205302",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031503",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954008510",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187031790",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954008520",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267005560",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205071120",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205071190",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335200905",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050701",
      "ndc_label_name": "Chlorzoxazone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162150502",
      "ndc_label_name": "Cholestyramine Light Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658027197",
      "ndc_label_name": "Cholestyramine Light Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224000910",
      "ndc_label_name": "Cholestyramine Light Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884046667",
      "ndc_label_name": "Cholestyramine Light POWDER 4 GM/DOSE ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382052942",
      "ndc_label_name": "Cholestyramine Light POWDER 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094090610",
      "ndc_label_name": "Cholestyramine Light Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806027193",
      "ndc_label_name": "Cholestyramine Light Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806027197",
      "ndc_label_name": "Cholestyramine Light Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877042224",
      "ndc_label_name": "Cholestyramine Light Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135093754",
      "ndc_label_name": "Cholestyramine Light Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629216201",
      "ndc_label_name": "Cholestyramine Light Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382052842",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026693",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241013451",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026697",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806026797",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335290201",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224001110",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342029371",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162150402",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806026793",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094080610",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629216401",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884046566",
      "ndc_label_name": "Cholestyramine POWDER 4 GM/DOSE ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559062037",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135000856",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629919601",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877029837",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162183402",
      "ndc_label_name": "Cholestyramine Powder 4 GM/DOSE Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629862401",
      "ndc_label_name": "Ciclopirox Olamine Cream 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162139703",
      "ndc_label_name": "Ciclopirox Olamine Cream 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131801",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063815",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063818",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629862501",
      "ndc_label_name": "Ciclopirox Olamine Cream 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802013818",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802013811",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629862601",
      "ndc_label_name": "Ciclopirox Olamine Cream 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029735",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029792",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802013835",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063831",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131808",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131802",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999064615",
      "ndc_label_name": "Ciclopirox Olamine Cream 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162139709",
      "ndc_label_name": "Ciclopirox Olamine Cream 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029717",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425022501",
      "ndc_label_name": "Ciclopirox Olamine Cream 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162139702",
      "ndc_label_name": "Ciclopirox Olamine Cream 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002094563",
      "ndc_label_name": "Ciclopirox Olamine CREAM 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335286501",
      "ndc_label_name": "Ciclopirox Olamine Cream 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335271701",
      "ndc_label_name": "Ciclopirox Olamine Suspension 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802040046",
      "ndc_label_name": "Ciclopirox Olamine SUSPENSION 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168031430",
      "ndc_label_name": "Ciclopirox Olamine SUSPENSION 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802040049",
      "ndc_label_name": "Ciclopirox Olamine SUSPENSION 0.77 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315030960",
      "ndc_label_name": "Ciclopirox Olamine Suspension 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672132304",
      "ndc_label_name": "Ciclopirox Olamine Suspension 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672132303",
      "ndc_label_name": "Ciclopirox Olamine Suspension 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629862701",
      "ndc_label_name": "Ciclopirox Olamine Suspension 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162140603",
      "ndc_label_name": "Ciclopirox Olamine Suspension 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315030930",
      "ndc_label_name": "Ciclopirox Olamine Suspension 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629252201",
      "ndc_label_name": "Ciclopirox Olamine Suspension 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335291501",
      "ndc_label_name": "Ciclopirox Olamine Suspension 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162140606",
      "ndc_label_name": "Ciclopirox Olamine Suspension 0.77 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090656200",
      "ndc_label_name": "Ciclopirox Solution 8 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629862301",
      "ndc_label_name": "Ciclopirox Solution 8 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135081445",
      "ndc_label_name": "Ciclopirox Solution 8 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162207601",
      "ndc_label_name": "Ciclopirox Solution 8 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383041906",
      "ndc_label_name": "Ciclopirox Solution 8 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802014167",
      "ndc_label_name": "Ciclopirox SOLUTION 8 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162132102",
      "ndc_label_name": "Ciclopirox Solution 8 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922005351",
      "ndc_label_name": "Ciclopirox Solution 8 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788679706",
      "ndc_label_name": "Ciclopirox SOLUTION 8 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192071506",
      "ndc_label_name": "Ciclopirox Solution 8 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672530200",
      "ndc_label_name": "Ciclopirox SOLUTION 8 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875506",
      "ndc_label_name": "Ciclopirox Solution 8 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118997106",
      "ndc_label_name": "Ciclopirox SOLUTION 8 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335283601",
      "ndc_label_name": "Ciclopirox Solution 8 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162229802",
      "ndc_label_name": "Ciclopirox Solution 8 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093206406",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185022305",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093206450",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185022360",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054004421",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505252201",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017711",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054004429",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291045360",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440701760",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135098660",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629879501",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267129760",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436015706",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017715",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518271400",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518220000",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003753",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267129706",
      "ndc_label_name": "Cilostazol TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081326",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436005106",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082226",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003760",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003780",
      "ndc_label_name": "Cilostazol Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017615",
      "ndc_label_name": "Cilostazol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054002821",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629879601",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440701591",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093206506",
      "ndc_label_name": "Cilostazol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090669000",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011660",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436005006",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135098360",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436015606",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518220800",
      "ndc_label_name": "Cilostazol Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017611",
      "ndc_label_name": "Cilostazol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505252101",
      "ndc_label_name": "Cilostazol TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502045093",
      "ndc_label_name": "Cimduo Tablet 300-300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00363002265",
      "ndc_label_name": "Cimetidine 200 TABLET 200 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363002271",
      "ndc_label_name": "Cimetidine 200 TABLET 200 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363002272",
      "ndc_label_name": "Cimetidine 200 TABLET 200 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363002239",
      "ndc_label_name": "Cimetidine 200 TABLET 200 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121064940",
      "ndc_label_name": "Cimetidine HCl Solution 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121064908",
      "ndc_label_name": "Cimetidine HCl Solution 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383096608",
      "ndc_label_name": "Cimetidine HCl Solution 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383005008",
      "ndc_label_name": "Cimetidine HCl Solution 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121102508",
      "ndc_label_name": "Cimetidine HCl Solution 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135080924",
      "ndc_label_name": "Cimetidine HCl Solution 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135080905",
      "ndc_label_name": "Cimetidine HCl Solution 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135080937",
      "ndc_label_name": "Cimetidine HCl Solution 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728194",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728192",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093819201",
      "ndc_label_name": "Cimetidine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378031701",
      "ndc_label_name": "Cimetidine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728115",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093819205",
      "ndc_label_name": "Cimetidine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728130",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728108",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999011221",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999011230",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728104",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034520",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999011214",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728160",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289079910",
      "ndc_label_name": "Cimetidine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728191",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034500",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034560",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291021790",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034512",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034540",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452032420",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651082401",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629178302",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034530",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629178301",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034535",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267005630",
      "ndc_label_name": "Cimetidine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034590",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135063190",
      "ndc_label_name": "Cimetidine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093820405",
      "ndc_label_name": "Cimetidine TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728220",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378037201",
      "ndc_label_name": "Cimetidine TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728290",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999034860",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728206",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728230",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093820401",
      "ndc_label_name": "Cimetidine TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728291",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037514",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728260",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050000",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037516",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728292",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291021801",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728215",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999034830",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289058160",
      "ndc_label_name": "Cimetidine TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050001",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289058190",
      "ndc_label_name": "Cimetidine TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037520",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357400",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037500",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037502",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357401",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629149703",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037515",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629149704",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037530",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66685170303",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037550",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037560",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037540",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452032520",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037528",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037590",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289058120",
      "ndc_label_name": "Cimetidine TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135063290",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289058110",
      "ndc_label_name": "Cimetidine TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651082501",
      "ndc_label_name": "Cimetidine Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289058130",
      "ndc_label_name": "Cimetidine TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728390",
      "ndc_label_name": "Cimetidine Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728315",
      "ndc_label_name": "Cimetidine Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378054101",
      "ndc_label_name": "Cimetidine TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037640",
      "ndc_label_name": "Cimetidine Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093830501",
      "ndc_label_name": "Cimetidine TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037630",
      "ndc_label_name": "Cimetidine Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728360",
      "ndc_label_name": "Cimetidine Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452032620",
      "ndc_label_name": "Cimetidine Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037660",
      "ndc_label_name": "Cimetidine Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728391",
      "ndc_label_name": "Cimetidine Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440728330",
      "ndc_label_name": "Cimetidine Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651082601",
      "ndc_label_name": "Cimetidine Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037600",
      "ndc_label_name": "Cimetidine Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135063390",
      "ndc_label_name": "Cimetidine Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037620",
      "ndc_label_name": "Cimetidine Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037616",
      "ndc_label_name": "Cimetidine Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267025830",
      "ndc_label_name": "Cimetidine TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904750204",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714007801",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291045930",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044010",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044015",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722010330",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904706704",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598036730",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543096104",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407029530",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268015312",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436000704",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380088304",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067430",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862083105",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335037983",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268015311",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015030",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687051611",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052511",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050330",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052521",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862083130",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629876301",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162184303",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093015201",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687051621",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335276101",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629960801",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097041002",
      "ndc_label_name": "Cinacalcet HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044110",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714007901",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407029630",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862083205",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629876401",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044115",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436000804",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598036830",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335038083",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722010430",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015130",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543096204",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862083230",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046030",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629960701",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093015301",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067530",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380088404",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335276201",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162184403",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050430",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097041102",
      "ndc_label_name": "Cinacalcet HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543096304",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862083330",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335060083",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598036930",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044215",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714008001",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629876501",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407029730",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162184503",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877050530",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380088504",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629960601",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722010530",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044210",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862083305",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436000904",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162252703",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097041202",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067630",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046130",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865015230",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093015401",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335276301",
      "ndc_label_name": "Cinacalcet HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950038114",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543045714",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42195055014",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436065601",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090230200",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788819801",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571012025",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071410",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090088100",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571012050",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090422000",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59390021710",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959055705",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071425",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999069925",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002132002",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090175400",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090231000",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436071401",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919042105",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700073705",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090318400",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090088200",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314065605",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314065625",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919049105",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59390021702",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919079505",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118996805",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010222",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090421700",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187015005",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205030005",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187098505",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59390021705",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788819805",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314065610",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315030805",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436021001",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010223",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010221",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919079525",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002132001",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315030810",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187098510",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425049901",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315030802",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518204500",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518239000",
      "ndc_label_name": "Ciprofloxacin HCl Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440629001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440629014",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063041006",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729006",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729014",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143992701",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090214602",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440629020",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063041010",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729002",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090460003",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571041110",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729040",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729020",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090322100",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440629040",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547068810",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063041020",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090729701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090460000",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16252051401",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291021901",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090460001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714065102",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086700",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090729700",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090758100",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090537100",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063041014",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063041012",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073920",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012605",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739070010",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999033314",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086702",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700088410",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073910",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090214601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002027910",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760069010",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790501",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090729702",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090214600",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629132605",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442022201",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316000",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154208600",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629132606",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407077501",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090214603",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862007601",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442022210",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090729703",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037102",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788758003",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820002",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073906",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316002",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071005510",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037106",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002027906",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629132607",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790502",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788900602",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700088406",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090460002",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788758008",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071005506",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002027914",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629132608",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074920",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657067501",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073914",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887501",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071005521",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071005514",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071005520",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335083602",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189032306",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071005528",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002027920",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887508",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788758000",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788758001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071005530",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019310",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019320",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820003",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651086601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518046400",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808802",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788758006",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788758002",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019312",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051910",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887506",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037114",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518220202",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887500",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887504",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790503",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021410",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051912",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335083601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135030801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006806",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887503",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335186701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808803",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335083604",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021406",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335083603",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629132601",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335186702",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518283700",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038501",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335186704",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518283702",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335186703",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629132603",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189030406",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518283703",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789012401",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518283701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030206",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061606",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019314",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629132604",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030210",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021420",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030212",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788758004",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051914",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887502",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051920",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117000801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030220",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518109000",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021414",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019306",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021430",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030214",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051906",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904724395",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729110",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063042703",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143992801",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729106",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904708395",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729102",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729104",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063042706",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054704",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063042714",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729160",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729114",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571041250",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571041210",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729120",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054782",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054710",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054703",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356073314",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729130",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714065202",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356073306",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729191",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086930",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086906",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054706",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063042728",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904708361",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714065204",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054702",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063042710",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547068910",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092302",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054720",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904724361",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356073320",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092328",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063042779",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164805",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086400",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054730",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073000",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16252051501",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356073330",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086303",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313000",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090379108",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086910",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073028",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054728",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063042720",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164807",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086908",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090385200",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090562800",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092304",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687086001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086308",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063042730",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164808",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092310",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784300",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784308",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092306",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760007410",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054714",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090379101",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092320",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784301",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436604102",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547068950",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760007420",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164900",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054779",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407016520",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092330",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784303",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118012708",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999033401",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760081510",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090379105",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086920",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073004",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086304",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436604101",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657067650",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090379104",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005460",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090537300",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092314",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073006",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086305",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073014",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760068920",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090379107",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135030901",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090562100",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086300",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002026420",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164800",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073021",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760081506",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090537307",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629172403",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073030",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086301",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002026430",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164901",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073060",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760081530",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090537308",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267091906",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002026410",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086307",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005406",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090379100",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012705",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442022305",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784307",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267091914",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164803",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005420",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090379103",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760067610",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005414",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407016505",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267091920",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657067601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164804",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036110",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090537301",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760068910",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629101003",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073010",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267091960",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651086705",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090537305",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135030905",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090537303",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629172405",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629101008",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073020",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785702",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651097705",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784304",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001710",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090537304",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785706",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862007705",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005430",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785708",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429004220",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784305",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629101002",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090548300",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813603",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267091910",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135030928",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813600",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687086011",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002026401",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786401",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407016501",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869202",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001728",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869203",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005410",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002026406",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786402",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407016528",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788885600",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785704",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629101004",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788901200",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135030920",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651086701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073015",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788902401",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786408",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629172406",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788901201",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001760",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760081520",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813602",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002026414",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518036801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788885603",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862007701",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038605",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629101006",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442022301",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869201",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651097701",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518036804",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518069300",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267091930",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518036802",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629101007",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001706",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869208",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760067620",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518228601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518228603",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785700",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518036805",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629172408",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001714",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788885608",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036120",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518234100",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064907",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785703",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518234103",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084007001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629172404",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999030928",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001720",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518234105",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064910",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786406",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004510",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786403",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739055910",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001730",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004514",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064920",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788885602",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009306",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786404",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267091928",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518036803",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629101001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934031614",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064930",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518001005",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064960",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869200",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084007011",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518303500",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629101005",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205053620",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099710",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518036800",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099700",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788902402",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813608",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518306300",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629172407",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010930",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335007002",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518228602",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099714",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788902408",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788885601",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009314",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629172410",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174108",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335204608",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518422902",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242503",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117000901",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788901202",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205053610",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786400",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242502",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335245001",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934031606",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242504",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518127803",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788901208",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335007009",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117000902",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011130",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174107",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064906",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010820",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518306301",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788902400",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008183",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518127801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010802",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242505",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335007003",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010830",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518306302",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518234106",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033006",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004506",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789011820",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189024210",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174104",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789011801",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518306304",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518306303",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004510",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004530",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033020",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010810",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189024220",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051120",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205053614",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004520",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013014",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934031630",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004520",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033010",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189030006",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335007001",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064914",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009320",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010806",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335007004",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004530",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789052006",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010828",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335007007",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335007005",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099720",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033014",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335007008",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009501",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009502",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004514",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015983",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335134703",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099730",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019201",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174101",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013006",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049302",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049201",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174102",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335134706",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099755",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049301",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011114",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013020",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013030",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335204603",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189062710",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335245003",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335007000",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174103",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789006520",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174105",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335007006",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174106",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051114",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242501",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335134704",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189062320",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051130",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010814",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008118",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033028",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016402",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051110",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011120",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004506",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019202",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016401",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189062714",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049202",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036814",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008007820",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013010",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407077650",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143992950",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356026410",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135031050",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073430",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729220",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012850",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16252051605",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073460",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571041305",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073414",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099030",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862007850",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714065301",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442022450",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073420",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651087350",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071033120",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099010",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789012550",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071033114",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071033130",
      "ndc_label_name": "Ciprofloxacin HCl TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038750",
      "ndc_label_name": "Ciprofloxacin HCl Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054006258",
      "ndc_label_name": "Citalopram Hydrobromide SOLUTION 10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121169610",
      "ndc_label_name": "Citalopram Hydrobromide Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722056424",
      "ndc_label_name": "Citalopram Hydrobromide SOLUTION 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862007424",
      "ndc_label_name": "Citalopram Hydrobromide SOLUTION 10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135054047",
      "ndc_label_name": "Citalopram Hydrobromide Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54838054070",
      "ndc_label_name": "Citalopram Hydrobromide Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121169640",
      "ndc_label_name": "Citalopram Hydrobromide Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135054010",
      "ndc_label_name": "Citalopram Hydrobromide Solution 20 MG/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999054024",
      "ndc_label_name": "Citalopram Hydrobromide Solution 20 MG/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135054024",
      "ndc_label_name": "Citalopram Hydrobromide Solution 20 MG/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856007401",
      "ndc_label_name": "Citalopram Hydrobromide Solution 20 MG/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999054010",
      "ndc_label_name": "Citalopram Hydrobromide Solution 20 MG/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185037101",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729590",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668000909",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378623101",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090741901",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668000901",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090129800",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378623105",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904608461",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668000905",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806001901",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458098116",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034205",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668000930",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429017310",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517000",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806001910",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063048105",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063048130",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700078760",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050788",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090129802",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055703",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700078790",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090129801",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517001",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090252000",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760000930",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000505",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090252002",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090741900",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030902",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090252001",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090741902",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002157903",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517002",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000510",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034201",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760000990",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959060330",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700078730",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034230",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025990",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050713",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097082212",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025930",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000530",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429017330",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000501",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028830",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084073711",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187022090",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030901",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518255300",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645056954",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084073701",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518054201",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282020690",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097082207",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934039730",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055702",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282062890",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518054200",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030903",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934039790",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055701",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009010605",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282062810",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378623205",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001030",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001006",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063006360",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185037201",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001001",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063006330",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729330",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729390",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063006314",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806002010",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063006390",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378623201",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806002001",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353011645",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063068390",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904608561",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324703",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353064215",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090089203",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001005",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353020860",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353064260",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090250101",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063068360",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517201",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077815",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090277400",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722020710",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353064245",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959077360",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517202",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353011660",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959077330",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090089202",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324700",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063068330",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090089200",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002135906",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090643300",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353020845",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034301",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090250102",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324702",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353011615",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090250103",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050813",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655068052",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077845",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700085130",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518267100",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436091602",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353020815",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324701",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919038930",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034330",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077860",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005690",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934012730",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002135900",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353020830",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090643301",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000610",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700085190",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090089201",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000630",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335023803",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034305",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077830",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187020360",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084074401",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118116603",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517203",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071023190",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335023804",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760049530",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090250100",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000601",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009260",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005630",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090643302",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084074411",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009010705",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919038960",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517200",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518007000",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090643303",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000605",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090684600",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335023805",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458098016",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788080209",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959077352",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518007002",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050818",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645057054",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002135903",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009215",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429017410",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934053990",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050888",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518056100",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005660",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097082312",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429017430",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009302",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071023160",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009230",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919038990",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934030490",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788080203",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009245",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071023130",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934053930",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518007001",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162251705",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071023152",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335023801",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518007003",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282062990",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097082307",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335023806",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518191700",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162256705",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934012790",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009301",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518261700",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335023802",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518267101",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162251701",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162256701",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282020790",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282062910",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378623305",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729430",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378623301",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001101",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729490",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729415",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353009130",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185037301",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001108",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440729445",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001105",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806002101",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057345",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353011230",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353048115",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353011215",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353011253",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063067030",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001130",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353011260",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320800",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090273200",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057360",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353011245",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313601",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353048145",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806002110",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353048173",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090703900",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090273202",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090273201",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057330",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090694700",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057315",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517500",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034405",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436091701",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313602",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090288800",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187014030",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959098630",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313600",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517501",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789909",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458088916",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320802",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320801",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518260100",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788896209",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002136003",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050988",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518044900",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034401",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517502",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002136000",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222800",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518135701",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083890",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919039090",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050918",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919039030",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048030",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002136006",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429017501",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934034130",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071022230",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789906",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429017510",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000705",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645057154",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111034430",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788896203",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610041360",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518135702",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788896208",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097082412",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000710",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007130",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050913",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518260102",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518044901",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009030",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097082407",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054101",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042245",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335223201",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000701",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282020810",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007190",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518222801",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000730",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205076430",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645055954",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205076490",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789903",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610041260",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788896201",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282020890",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788896206",
      "ndc_label_name": "Citalopram Hydrobromide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009010805",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518260101",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042260",
      "ndc_label_name": "Citalopram Hydrobromide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00135019902",
      "ndc_label_name": "Citrucel Tablet 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00135019901",
      "ndc_label_name": "Citrucel Tablet 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00135019907",
      "ndc_label_name": "Citrucel Tablet 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536322301",
      "ndc_label_name": "Citrus Calcium/Vitamin D Tablet 200-6.25 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "33261087860",
      "ndc_label_name": "Citrus Calcium/Vitamin D Tablet 200-6.25 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "33261087890",
      "ndc_label_name": "Citrus Calcium/Vitamin D Tablet 200-6.25 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00781602246",
      "ndc_label_name": "Clarithromycin SUSPENSION RECONSTITUTED 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781602252",
      "ndc_label_name": "Clarithromycin SUSPENSION RECONSTITUTED 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781602346",
      "ndc_label_name": "Clarithromycin SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781602352",
      "ndc_label_name": "Clarithromycin SUSPENSION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090099400",
      "ndc_label_name": "Clarithromycin Suspension Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729628",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017815",
      "ndc_label_name": "Clarithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729620",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527193106",
      "ndc_label_name": "Clarithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781196160",
      "ndc_label_name": "Clarithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729604",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440729614",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017811",
      "ndc_label_name": "Clarithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090244100",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237004460",
      "ndc_label_name": "Clarithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135061660",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332034460",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862022560",
      "ndc_label_name": "Clarithromycin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090092700",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380090503",
      "ndc_label_name": "Clarithromycin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053020",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090183001",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781196260",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527193206",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904687204",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063053014",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082328",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063075228",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319301",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090183003",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063075214",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017913",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063082320",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063075220",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090251500",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319302",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083620",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090319300",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090183000",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135061560",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083610",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090251501",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268017911",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090528201",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002075610",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090528203",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090183002",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071033720",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083660",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090251502",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002075614",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090528202",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237004560",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862022660",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090528200",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001705",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919064310",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043511",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919064320",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959083614",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149304",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788848002",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712508",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001708",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919064328",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043521",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187037620",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002075620",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149305",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001702",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001701",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335079505",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187037614",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332034560",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071033730",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712503",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189029920",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001707",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001704",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149303",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187037628",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071033714",
      "ndc_label_name": "Clarithromycin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712501",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518277300",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380090603",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149302",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001706",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149308",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68002010402",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804014128",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788793302",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335001703",
      "ndc_label_name": "Clarithromycin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68002010404",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149309",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149307",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804006920",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788712502",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788793308",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788848008",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189029910",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149301",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189029928",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335149306",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189063920",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189063910",
      "ndc_label_name": "Clarithromycin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289076230",
      "ndc_label_name": "Clemastine Fumarate Tablet 1.34 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440729830",
      "ndc_label_name": "Clemastine Fumarate Tablet 1.34 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "64950026810",
      "ndc_label_name": "Clemastine Fumarate Tablet 2.68 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093030801",
      "ndc_label_name": "Clemastine Fumarate Tablet 2.68 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959050120",
      "ndc_label_name": "Clemastine Fumarate Tablet 2.68 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440730060",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001100",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440730006",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959074430",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440730004",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440730017",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571025101",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440730030",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001104",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090195103",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039404",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002023220",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090044304",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039406",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039415",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904595961",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090044306",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198506",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039421",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002023280",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090466100",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039417",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039430",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039428",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090195101",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090466103",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039442",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762332801",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090700700",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039420",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090195106",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039440",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198504",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090466106",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039460",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629281705",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090737403",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039456",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090195107",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090044303",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198507",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090737400",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039480",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629281706",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005720",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001140",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090737401",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090044307",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002023299",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959074440",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001118",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775301",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073860",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090044300",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090737404",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090195100",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005740",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002023228",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090044301",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775303",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304069205",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090737406",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090737407",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198501",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187024728",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002023242",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090195104",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775306",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629281701",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407037301",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959074442",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090322200",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073821",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154682700",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198500",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518042405",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862018501",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348066028",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002023230",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090466104",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073830",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629281704",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198503",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020003",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006008",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760033728",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005730",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090466107",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304069201",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724002",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090466101",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020006",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006010",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760033760",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629281707",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959074420",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629281702",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724007",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407037305",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020009",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084024301",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082828",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629281708",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002023240",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006006",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518042400",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187024721",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018006",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855805",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082860",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724008",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002023256",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724000",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020001",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629281703",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002023260",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934021630",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073828",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775300",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760048728",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724001",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018008",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084024311",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760048760",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020004",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629281709",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775305",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005721",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724006",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462014305",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462014301",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919031030",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018021",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775302",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020007",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135076501",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518042401",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775308",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724005",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862018505",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518042404",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934014480",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018030",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006004",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005280",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020002",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518042402",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006014",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018004",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020005",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018040",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724003",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020000",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020008",
      "ndc_label_name": "Clindamycin HCl CAPSULE 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018056",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775307",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018015",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018028",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018042",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018020",
      "ndc_label_name": "Clindamycin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527138302",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090250204",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440730520",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090096704",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440730528",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904719461",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440730540",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571025201",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090179800",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735401",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090250202",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090390700",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090096700",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090096703",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090096701",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090096702",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090390702",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078428",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090457503",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090390701",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324203",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090250200",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324201",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090250203",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268018511",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082730",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090766900",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090457500",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090765900",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090250201",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324204",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324200",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289089030",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012740",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078440",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090457502",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289089015",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090390704",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090390703",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324202",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760048410",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187014128",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289089009",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078421",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919044128",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090390705",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735400",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735402",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919044130",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187055630",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289089028",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289089021",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012730",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090457501",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735403",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735405",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082930",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862018601",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289089056",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760042730",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071039890",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090457504",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289089040",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919044120",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187014140",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071039820",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289089090",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919044140",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462052281",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090735404",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762501001",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135076601",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187038121",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084024401",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082921",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071039806",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868501",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268018515",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762501002",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187014121",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187055628",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084024411",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082940",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071039814",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004840",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078404",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760069310",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187055640",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462014401",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868502",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012728",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071039830",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045301",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078416",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082710",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304069301",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821903",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518215300",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071039845",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821902",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821906",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078430",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187038130",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868503",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868505",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518215303",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518215301",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821905",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868508",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289089001",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304069316",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868506",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205044421",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004830",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518215304",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821908",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205044428",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289089004",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934069330",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789016730",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205044430",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045300",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045304",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518215302",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045302",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289089020",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020720",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518273500",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045305",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189018940",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045306",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045308",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045307",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700076121",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020721",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189018921",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335141201",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789016720",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045309",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700076130",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789016709",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020709",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020212",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700076140",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789016721",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014503",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335141205",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760048420",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010301",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041601",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020230",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012720",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014501",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012721",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335243201",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187014130",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041603",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187038120",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020290",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071039840",
      "ndc_label_name": "Clindamycin HCl CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189018930",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821901",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789016740",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821904",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020740",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868504",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014502",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205044440",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045303",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189018928",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020730",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020201",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020220",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020260",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041602",
      "ndc_label_name": "Clindamycin HCl Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135056919",
      "ndc_label_name": "Clindamycin Palmitate HCl SOLUTION RECONSTITUTED 75 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629252301",
      "ndc_label_name": "Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762001601",
      "ndc_label_name": "Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746046819",
      "ndc_label_name": "Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629239101",
      "ndc_label_name": "Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714048302",
      "ndc_label_name": "Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574012901",
      "ndc_label_name": "Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155060351",
      "ndc_label_name": "Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714048301",
      "ndc_label_name": "Clindamycin Palmitate HCl SOLUTION RECONSTITUTED 75 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162046819",
      "ndc_label_name": "Clindamycin Palmitate HCl SOLUTION RECONSTITUTED 75 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162180901",
      "ndc_label_name": "Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980051110",
      "ndc_label_name": "Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162110701",
      "ndc_label_name": "Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862059602",
      "ndc_label_name": "Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862059601",
      "ndc_label_name": "Clindamycin Palmitate HCl SOLUTION RECONSTITUTED 75 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682046275",
      "ndc_label_name": "Clindamycin Phos (Once-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238203107",
      "ndc_label_name": "Clindamycin Phos (Once-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72336011275",
      "ndc_label_name": "Clindamycin Phos (Once-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73473030275",
      "ndc_label_name": "Clindamycin Phos (Once-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714016102",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802090094",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168020230",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238203006",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168020260",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578011801",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672139902",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714016101",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922002707",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090607200",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332062330",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73473030060",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762374301",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672139903",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332062360",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922002705",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629863001",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842306",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629930901",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802090096",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462086635",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090076800",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238203003",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090595800",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578011802",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762374302",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162143606",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629863101",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73473030030",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462086665",
      "ndc_label_name": "Clindamycin Phos (Twice-Daily) Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168027740",
      "ndc_label_name": "Clindamycin Phosphate CREAM 2 % VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090138300",
      "ndc_label_name": "Clindamycin Phosphate Cream 2 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762500901",
      "ndc_label_name": "Clindamycin Phosphate CREAM 2 % VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238203003",
      "ndc_label_name": "Clindamycin Phosphate Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714024601",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335295301",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762374401",
      "ndc_label_name": "Clindamycin Phosphate LOTION 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118996406",
      "ndc_label_name": "Clindamycin Phosphate LOTION 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672140004",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162139506",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168020360",
      "ndc_label_name": "Clindamycin Phosphate LOTION 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922003601",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629863201",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162214706",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629945901",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802012801",
      "ndc_label_name": "Clindamycin Phosphate Lotion 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090659300",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090308600",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168020130",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002083781",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802056201",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922000221",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168020160",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922000201",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781006",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090659200",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090577900",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162141803",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802056202",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799006",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135069161",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261100",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335286301",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118996203",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672408103",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162141806",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999074930",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578008403",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335286101",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002083783",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672408104",
      "ndc_label_name": "Clindamycin Phosphate SOLUTION 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71428000330",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71428000360",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603032101",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629863301",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629863401",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578008402",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603032102",
      "ndc_label_name": "Clindamycin Phosphate Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71791000111",
      "ndc_label_name": "Clinical Nutrients Prenatal Tablet 7.5-0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00832058011",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571031501",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527168101",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781801301",
      "ndc_label_name": "cloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407058501",
      "ndc_label_name": "cloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687042311",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672420201",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722063901",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714088701",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205004791",
      "ndc_label_name": "cloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710132501",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991090001",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687042321",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011420",
      "ndc_label_name": "cloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877066501",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180015701",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238130501",
      "ndc_label_name": "CloBAZam Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714088801",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571031601",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781801401",
      "ndc_label_name": "cloBAZam Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527168201",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205004891",
      "ndc_label_name": "cloBAZam Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832058111",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672420301",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991090101",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722064001",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710132601",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180015801",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011520",
      "ndc_label_name": "cloBAZam Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407058601",
      "ndc_label_name": "cloBAZam Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238130601",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877066601",
      "ndc_label_name": "CloBAZam Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922006127",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571036299",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386002860",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63646050025",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342032186",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168026950",
      "ndc_label_name": "Clobetasol Propionate SOLUTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407073750",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526400",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571036281",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432013350",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090308500",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383026625",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752015304",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922006122",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672129303",
      "ndc_label_name": "Clobetasol Propionate SOLUTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432013325",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383026650",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63646050050",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332048650",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752015320",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407073725",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672129302",
      "ndc_label_name": "Clobetasol Propionate SOLUTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462053253",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332048625",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462053228",
      "ndc_label_name": "Clobetasol Propionate Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571068303",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714084902",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378302501",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714084903",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135069801",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406880601",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904703807",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440730730",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571068309",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407075701",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832063011",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672401106",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714084901",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571034201",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651038101",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781202701",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241021030",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672401101",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651038190",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651038130",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241021001",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091030",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180049206",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571034230",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672401105",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180049201",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238110809",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429028701",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746071090",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091060",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091055",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407031501",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710106503",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238110803",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72664021490",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084079025",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091000",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817028010",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091011",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710106501",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746071030",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756040511",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332040731",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084079095",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315016701",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091090",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241021130",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781203701",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378305001",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904703907",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440730830",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241021101",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085001",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406880701",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407075801",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085003",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651038230",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135069901",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832063111",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407031601",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571034330",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571068403",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672401201",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651038290",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710106603",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085002",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651038201",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710106601",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332040831",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571068409",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746071130",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756040611",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091111",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672401206",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746071190",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091190",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084081825",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571034301",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180049301",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672401205",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72664021590",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817028110",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238110903",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429028901",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180049306",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084081895",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091155",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238110909",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315016601",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091100",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091130",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091160",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440730930",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832063211",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378307501",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571034401",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406880801",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085103",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571068509",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085101",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407031701",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241021230",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135070001",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672401305",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746071230",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746071290",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672401301",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817028210",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407075901",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238111003",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571068503",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651038330",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238111009",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315016501",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651038301",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332040931",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629111101",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710106701",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085102",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180049401",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162197701",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091200",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651038390",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180049406",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241021201",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091290",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091211",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571034430",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091230",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672401306",
      "ndc_label_name": "ClomiPRAMINE HCl CAPSULE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72664021690",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429028801",
      "ndc_label_name": "clomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710106703",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756040711",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091255",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091260",
      "ndc_label_name": "ClomiPRAMINE HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093083201",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030710",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208800",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228300311",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030728",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013600",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093083205",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732090",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732030",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030715",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090484102",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732060",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030754",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030745",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732091",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013616",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030746",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030753",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436091302",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904722761",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030770",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030792",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030714",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436091305",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040611",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030775",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052430",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079730",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436294801",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040610",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030720",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436294802",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999032815",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030780",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000990",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079760",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118294806",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090282300",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030730",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052405",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436136001",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040650",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687054401",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436091301",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687054411",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017311",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030755",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000900",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052460",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999032890",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052955",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052445",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788739406",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052412",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030760",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700056460",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000960",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208802",
      "ndc_label_name": "ClonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052960",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700056430",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788739409",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052415",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436136002",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052401",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651072299",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017315",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052970",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760027360",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842002",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052405",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052401",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052412",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687086101",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052451",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052980",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052928",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518180100",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052460",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000912",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052430",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687086111",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052490",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788739403",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052954",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518239200",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052490",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651072201",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052445",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187022630",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959000930",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003960",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052975",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335250902",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629120201",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052415",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052451",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629120101",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005860",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008410",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842003",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003915",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052930",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005830",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518180101",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052915",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629120301",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008453",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518129702",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003975",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052953",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005890",
      "ndc_label_name": "ClonazePAM TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518246702",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052945",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544052910",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036820",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518250700",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003980",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518239201",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135076990",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335181004",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788739402",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842006",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036830",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008415",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008414",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335181002",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187060330",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335250904",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842009",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518129701",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085528",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008455",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036814",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335181003",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518246700",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003953",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003930",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518250701",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086353",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036892",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036815",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008454",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518246701",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003970",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008428",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205082730",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086354",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085514",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036880",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036845",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008470",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003992",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008430",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003945",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086370",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085545",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079010",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079028",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008475",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008420",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008446",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003955",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008130",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085554",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079015",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079055",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008492",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008445",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079045",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008460",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008160",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086355",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085515",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086320",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036846",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008480",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079060",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036810",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603030702",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162136405",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085553",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425035803",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036855",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086346",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079070",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036828",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036870",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015200",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085560",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036853",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036875",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086380",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085510",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036854",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079046",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015201",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086330",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036860",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079053",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603030701",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085520",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079020",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086315",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425040201",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425040203",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079030",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086328",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012503",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085530",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085570",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086345",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425040202",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085580",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162136400",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030730",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162136401",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086310",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008190",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012502",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015205",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015230",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012501",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425035801",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425035802",
      "ndc_label_name": "clonazePAM Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732191",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093321201",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732160",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013700",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093321205",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079430",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904772861",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732190",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079460",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027730",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030828",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013716",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732130",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027746",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090202202",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030815",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027755",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030846",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651072399",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030830",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030853",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027780",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090429900",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030854",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027775",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030880",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052590",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030855",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017415",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040710",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436091503",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030860",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017411",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055501",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187088860",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651072301",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959063090",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040750",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959063000",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030870",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959063002",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687087201",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898801",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052512",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052501",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959063018",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959063030",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030875",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959063060",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687087211",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847302",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052515",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052560",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048530",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083030",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040711",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025646",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187088830",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847309",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005930",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055511",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025615",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083060",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118294903",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518135300",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898802",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518253301",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048590",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629111601",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025630",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052505",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052530",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518233401",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773806",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184303",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898803",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025680",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025645",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760030030",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052545",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518253302",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773809",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004053",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025675",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773802",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025653",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005960",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025670",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518314400",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847306",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004075",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773803",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773808",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025660",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005990",
      "ndc_label_name": "ClonazePAM TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840102",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002209",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518135302",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004080",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840106",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335241402",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518135301",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048560",
      "ndc_label_name": "ClonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847303",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184304",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002200",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008546",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518314402",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004028",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518152102",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135077090",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847308",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004055",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335241404",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008560",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002203",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004070",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518233400",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629120401",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518152101",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008555",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008515",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008570",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002204",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008575",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002205",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629120501",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518253300",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036353",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008530",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036330",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004030",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036370",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002206",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025655",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205052930",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036615",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036345",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036355",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036346",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036654",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036315",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840103",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335184302",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036655",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036380",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077115",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036360",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085212",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036328",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840108",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004015",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085246",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036628",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077180",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036375",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189047560",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036646",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840109",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004045",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603030801",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036653",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085215",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036670",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013502",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085260",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518314401",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004060",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085245",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036660",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002201",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077154",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085253",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077128",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002202",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008545",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015300",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077130",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002207",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603030802",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015305",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077153",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002208",
      "ndc_label_name": "ClonazePAM TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008553",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013501",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077160",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008580",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425035701",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036630",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085230",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036645",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036354",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036680",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085280",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077145",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425035702",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603030803",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031430",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077146",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015301",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077170",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015330",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085228",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425035703",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189047530",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013503",
      "ndc_label_name": "clonazePAM Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732230",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732260",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079970",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013800",
      "ndc_label_name": "ClonazePAM TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093321305",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041253",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013816",
      "ndc_label_name": "ClonazePAM TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093321301",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999051830",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063078830",
      "ndc_label_name": "ClonazePAM TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313300",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959076130",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732290",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002353",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959076110",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079945",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017511",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090296500",
      "ndc_label_name": "ClonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959076100",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959076160",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079915",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036715",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651072401",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040810",
      "ndc_label_name": "ClonazePAM TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052605",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052601",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651072405",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135077190",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999051860",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081770",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052660",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040850",
      "ndc_label_name": "ClonazePAM TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629120601",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052630",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052690",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041245",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268017515",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603030901",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267090430",
      "ndc_label_name": "ClonazePAM TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959076102",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629120701",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041230",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849906",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041280",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518155902",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041270",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718102",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041260",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267090490",
      "ndc_label_name": "ClonazePAM TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718103",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878109",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849902",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002330",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718106",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718109",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849903",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544041215",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878102",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518155901",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002370",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007570",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518223200",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878103",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849909",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878106",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248502",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248501",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036730",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039030",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007545",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039045",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185603",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518223201",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039060",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248504",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036745",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074945",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039070",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081746",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007515",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248500",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015405",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002345",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036753",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081745",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015430",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002360",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007530",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518248503",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081730",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039053",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036760",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081753",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039015",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162136605",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074915",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002315",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074930",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015400",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074953",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081760",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074960",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007553",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074980",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603030902",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081715",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162136601",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031530",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888015401",
      "ndc_label_name": "clonazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228212750",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135070805",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228212710",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732510",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632500",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632590",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632505",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632585",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632530",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081708",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632560",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732515",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632501",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732560",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081730",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732590",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632581",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674402",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135070801",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300013501",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732594",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732592",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190800",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300013510",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732530",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674407",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081715",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300013505",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300046810",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904744261",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090436000",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012700",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300046805",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090700900",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081760",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300046801",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353066080",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090557708",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090436001",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012790",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190801",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489021510",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547056510",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674401",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547056511",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747700",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090436007",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090436002",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190802",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919071890",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012704",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817018000",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012712",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268019211",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747500",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090436008",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190807",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006130",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090277500",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071890",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012720",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071830",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747501",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090557701",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190808",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006190",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674408",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657064710",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090557700",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760005730",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268019215",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090557702",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090557707",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849406",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747507",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760017890",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674400",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919026690",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071812",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071800",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747502",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518089801",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817018010",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332005471",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090694600",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060560",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071840",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687011301",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747508",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162167905",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657064750",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187041912",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071860",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060590",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700070430",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919026660",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071805",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789009115",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629231401",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187041920",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700070490",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629132804",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657064701",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919071830",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489021501",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788714506",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629231501",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849409",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651023201",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518196203",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760099230",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629132801",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760005790",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205057030",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006160",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518196200",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651023299",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205058860",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919026630",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006106",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518196202",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518196201",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006191",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001023700",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687011311",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934079390",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060530",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001023703",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934027130",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934085130",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849401",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788714501",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760017830",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518089802",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332005431",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518089803",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335226604",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518089805",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849403",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934027190",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919071860",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934079330",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332005491",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162167900",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629132802",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789009108",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518035003",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789009130",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788714503",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789009160",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629132803",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518089804",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518128301",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335077701",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629132806",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335077706",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205057060",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162167901",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006112",
      "ndc_label_name": "CloNIDine HCl TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788714509",
      "ndc_label_name": "CloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518196204",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518196205",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518316200",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205058812",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205058830",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335077702",
      "ndc_label_name": "cloNIDine HCl Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632605",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228212850",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732694",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228212810",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632600",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135070905",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632681",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632660",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353015160",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632685",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190900",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632630",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632601",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999025800",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732630",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632690",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353050960",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732692",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190906",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353050980",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300013601",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651023305",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135070901",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732660",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547056611",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904744361",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090260000",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090260005",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300013610",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006260",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090315106",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732690",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090260006",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300013605",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006292",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332005571",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092530",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001023803",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817018100",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353015180",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657064810",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547056610",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788768509",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629231601",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353066160",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788768503",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817018110",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999025890",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629275303",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190901",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162168005",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629275302",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353066180",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808006",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657064801",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090315101",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629926901",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268019311",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332005531",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006214",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190905",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518329500",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332005591",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079030063",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518195901",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687012411",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001023800",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006290",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090315100",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162168000",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205082990",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078830",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090315105",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919026730",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162168001",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788768506",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268019315",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629275301",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489021610",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489021601",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657064850",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205082930",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687012401",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205021830",
      "ndc_label_name": "CloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006230",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651023301",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808003",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919026760",
      "ndc_label_name": "CloNIDine HCl TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808009",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629231701",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518195900",
      "ndc_label_name": "cloNIDine HCl Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092430",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817018200",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092490",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440632701",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135071001",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298301",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228212910",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300013705",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547056710",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001023900",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999043800",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440732706",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031609",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657064901",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332005671",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489021701",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999043830",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816303",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268019415",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300013701",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090191001",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657064910",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629231901",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657064950",
      "ndc_label_name": "CloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817018210",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816306",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651023401",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651023405",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268019411",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629231801",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629928901",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162168101",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267046460",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816301",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267046430",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332005631",
      "ndc_label_name": "CloNIDine HCl TABLET 0.3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518181100",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335288901",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518181101",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816309",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044909",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518100000",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162168100",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162168105",
      "ndc_label_name": "cloNIDine HCl Tablet 0.3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668014190",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722090190",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904629461",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668014130",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714005201",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714005203",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729021810",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342006015",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722090105",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342006010",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668014105",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729021815",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090656700",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714005211",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063037160",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090746601",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722090130",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598012190",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714005202",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090578101",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228012430",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729021816",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353026930",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228012410",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090259800",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208200",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714005204",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090586800",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117101001",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598012130",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353026960",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505025303",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819006",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208201",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714005210",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228012490",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367020005",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090656800",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335089483",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788770006",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117101002",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090259801",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342006007",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407003290",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205007390",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090746600",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090578100",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008001",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518040000",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090656701",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063037130",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429030110",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335058101",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228012405",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090746700",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335058104",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205007330",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407003210",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063037190",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862035730",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71717010109",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111019690",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458088816",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205019990",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008003",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407003230",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598012105",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764503",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009002105",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429030130",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505025302",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764506",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335075201",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111019630",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335089481",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764509",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71717010103",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429030190",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000730",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819009",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205019930",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919073790",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090130100",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518040001",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046990",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862035705",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862035790",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335075202",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090130101",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62034001577",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877027690",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71717010150",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111019605",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877027605",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084053601",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162221200",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862035701",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117101003",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084053611",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771012410",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862035761",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645059090",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788770009",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771012430",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518047100",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117101004",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819003",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009018205",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934070890",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788770003",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518047102",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610052760",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008004",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008002",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335058102",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205019901",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771012490",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335058103",
      "ndc_label_name": "Clopidogrel Bisulfate TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009002190",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205019905",
      "ndc_label_name": "Clopidogrel Bisulfate Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107028401",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063003012",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107032101",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404401",
      "ndc_label_name": "Clorazepate Dipotassium TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063089306",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378007001",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954015710",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603011401",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063003010",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954015720",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025606",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063003003",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162210001",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063003006",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505475601",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954015740",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107028201",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954015930",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378003005",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404202",
      "ndc_label_name": "Clorazepate Dipotassium TABLET 3.75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087360",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107031905",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378003001",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954015910",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107031901",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603011201",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107028205",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087330",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404201",
      "ndc_label_name": "Clorazepate Dipotassium TABLET 3.75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505475401",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954015950",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 3.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107028305",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107028301",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954015810",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378004005",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378004001",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404301",
      "ndc_label_name": "Clorazepate Dipotassium TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107032005",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999067400",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107032001",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404302",
      "ndc_label_name": "Clorazepate Dipotassium TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954015850",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087430",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603011301",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087460",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505475501",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954015830",
      "ndc_label_name": "Clorazepate Dipotassium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "36800006200",
      "ndc_label_name": "Clotrimazole 3 CREAM 2 % VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917003586",
      "ndc_label_name": "Clotrimazole 3 CREAM 2 % VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007847",
      "ndc_label_name": "Clotrimazole 3 CREAM 2 % VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50228050261",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228050230",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536144370",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672203701",
      "ndc_label_name": "Clotrimazole SOLUTION 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "13874002051",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536118170",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50228050208",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135067191",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672126003",
      "ndc_label_name": "Clotrimazole SOLUTION 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162217803",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135067181",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52817080030",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268004430",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54633001810",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70795802001",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399050001",
      "ndc_label_name": "Clotrimazole SOLUTION 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70954003620",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71399066606",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788408001",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399066603",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54633001830",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399050003",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71297003002",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82568003606",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83474000334",
      "ndc_label_name": "Clotrimazole Solution 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00574010714",
      "ndc_label_name": "Clotrimazole Troche 10 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571068614",
      "ndc_label_name": "Clotrimazole Troche 10 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054414623",
      "ndc_label_name": "Clotrimazole TROCHE 10 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574010777",
      "ndc_label_name": "Clotrimazole Troche 10 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574010770",
      "ndc_label_name": "Clotrimazole Troche 10 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054814622",
      "ndc_label_name": "Clotrimazole Troche 10 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054414622",
      "ndc_label_name": "Clotrimazole TROCHE 10 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571068607",
      "ndc_label_name": "Clotrimazole Troche 10 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49022008436",
      "ndc_label_name": "Clotrimazole-7 CREAM 1 % VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00093777219",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093777201",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729014216",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378086002",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093777205",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862090205",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664034788",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378086005",
      "ndc_label_name": "CloZAPine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093777293",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378086007",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079092201",
      "ndc_label_name": "CloZAPine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079092220",
      "ndc_label_name": "CloZAPine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378086001",
      "ndc_label_name": "CloZAPine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518339100",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687041511",
      "ndc_label_name": "CloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862027305",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664034713",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440731790",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862027301",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407008601",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429099001",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440731791",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862084605",
      "ndc_label_name": "CloZAPine TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862090201",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862084601",
      "ndc_label_name": "CloZAPine TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904708761",
      "ndc_label_name": "CloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518339101",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687041501",
      "ndc_label_name": "CloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729014201",
      "ndc_label_name": "CloZAPine TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429099005",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407008605",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629236001",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629235901",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162163802",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72721176005",
      "ndc_label_name": "cloZAPine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378097301",
      "ndc_label_name": "CloZAPine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093440519",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862027401",
      "ndc_label_name": "CloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093440593",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093440505",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093440501",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518335700",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629236201",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378097302",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079074920",
      "ndc_label_name": "CloZAPine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862084701",
      "ndc_label_name": "CloZAPine TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904708861",
      "ndc_label_name": "CloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862090305",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862090301",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518335701",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079074901",
      "ndc_label_name": "CloZAPine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687042601",
      "ndc_label_name": "CloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862027405",
      "ndc_label_name": "CloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72721177005",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664021188",
      "ndc_label_name": "cloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687042611",
      "ndc_label_name": "CloZAPine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862084401",
      "ndc_label_name": "CloZAPine TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904708961",
      "ndc_label_name": "CloZAPine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862090001",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687040401",
      "ndc_label_name": "CloZAPine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093435901",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378082502",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093435919",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093435905",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079092101",
      "ndc_label_name": "CloZAPine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729014101",
      "ndc_label_name": "CloZAPine TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378082501",
      "ndc_label_name": "CloZAPine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093435993",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079092120",
      "ndc_label_name": "CloZAPine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729014116",
      "ndc_label_name": "CloZAPine TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429098901",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440731560",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407008501",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862090005",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664034588",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687040411",
      "ndc_label_name": "CloZAPine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72721172505",
      "ndc_label_name": "cloZAPine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664024188",
      "ndc_label_name": "cloZAPine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093440401",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687054801",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72721175005",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093440493",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904740661",
      "ndc_label_name": "cloZAPine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629236101",
      "ndc_label_name": "cloZAPine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093440405",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378097201",
      "ndc_label_name": "CloZAPine TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378097202",
      "ndc_label_name": "cloZAPine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687054811",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093440419",
      "ndc_label_name": "CloZAPine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862084501",
      "ndc_label_name": "CloZAPine TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862090105",
      "ndc_label_name": "cloZAPine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862090101",
      "ndc_label_name": "cloZAPine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462102008",
      "ndc_label_name": "CO Monitor Replacement Pieces",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10267227001",
      "ndc_label_name": "Co-Natal FA TABLET ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054024424",
      "ndc_label_name": "Codeine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054024425",
      "ndc_label_name": "Codeine Sulfate TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527169801",
      "ndc_label_name": "Codeine Sulfate TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054024525",
      "ndc_label_name": "Codeine Sulfate Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00254200801",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378108693",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904712004",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292005401",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00254200811",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378108601",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591256201",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591256230",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155085503",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714003901",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292005403",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629216601",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714003902",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155085501",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722089901",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072711",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884017101",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722089930",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008201",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135078930",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205068730",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598037201",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598037230",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010000203",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268018715",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268018711",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651045501",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205068705",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072765",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598037210",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090720507",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049403",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380079604",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038911",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010000201",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189024903",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205068721",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884017111",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162071009",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038921",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710135101",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008230",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205031030",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072721",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205068710",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651045530",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135078990",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629216701",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629876601",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380079606",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189033103",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162071003",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005430",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877058901",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710135103",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162185501",
      "ndc_label_name": "Colchicine Tablet 0.6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742026301",
      "ndc_label_name": "Colchicine-Probenecid Tablet 0.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591532501",
      "ndc_label_name": "Colchicine-Probenecid TABLET 0.5-500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571083201",
      "ndc_label_name": "Colchicine-Probenecid Tablet 0.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70000051501",
      "ndc_label_name": "Cold & Flu Relief Daytime Capsule 10-5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00363047608",
      "ndc_label_name": "Cold Multi-Symptom Daytime TABLET 10-5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53746005001",
      "ndc_label_name": "Cold Tablets TABLET 30-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30142013962",
      "ndc_label_name": "Cold/Allergy PE TABLET 4-10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70518269301",
      "ndc_label_name": "Colestipol HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762045001",
      "ndc_label_name": "Colestipol HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115521116",
      "ndc_label_name": "Colestipol HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687071511",
      "ndc_label_name": "Colestipol HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799011501",
      "ndc_label_name": "Colestipol HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559039512",
      "ndc_label_name": "Colestipol HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742028412",
      "ndc_label_name": "Colestipol HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518269300",
      "ndc_label_name": "Colestipol HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687071521",
      "ndc_label_name": "Colestipol HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710146707",
      "ndc_label_name": "Colestipol HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069236210",
      "ndc_label_name": "Comirnaty Suspension 30 MCG/0.3ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069236201",
      "ndc_label_name": "Comirnaty Suspension 30 MCG/0.3ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069239210",
      "ndc_label_name": "Comirnaty Suspension Prefilled Syringe 30 MCG/0.3ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069239201",
      "ndc_label_name": "Comirnaty Suspension Prefilled Syringe 30 MCG/0.3ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61958110101",
      "ndc_label_name": "Complera Tablet 200-25-300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11917011600",
      "ndc_label_name": "Complete Multivitamin/Mineral Liquid Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "13811001490",
      "ndc_label_name": "CompleteNate Tablet Chewable 29-1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629844401",
      "ndc_label_name": "Compro Suppository 25 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574722612",
      "ndc_label_name": "Compro SUPPOSITORY 25 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090288102",
      "ndc_label_name": "Compro Suppository 25 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63044003112",
      "ndc_label_name": "Condoms",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55513080060",
      "ndc_label_name": "Corlanor Tablet 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518330900",
      "ndc_label_name": "Corlanor Tablet 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513081060",
      "ndc_label_name": "Corlanor Tablet 7.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078063998",
      "ndc_label_name": "Cosentyx (300 MG Dose) Solution Prefilled Syringe 150 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078063941",
      "ndc_label_name": "Cosentyx Sensoready (300 MG) Solution Auto-Injector 150 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078063968",
      "ndc_label_name": "Cosentyx Sensoready Pen Solution Auto-injector 150 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078063997",
      "ndc_label_name": "Cosentyx Solution Prefilled Syringe 150 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078105697",
      "ndc_label_name": "Cosentyx Solution Prefilled Syringe 75 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078107068",
      "ndc_label_name": "Cosentyx UnoReady Solution Auto-Injector 300 MG/2ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078107096",
      "ndc_label_name": "Cosentyx UnoReady Solution Auto-Injector 300 MG/2ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "41520031886",
      "ndc_label_name": "Cough Relief Liquid 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00111070752",
      "ndc_label_name": "COVID-19 At-Home Test Kit In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00111070772",
      "ndc_label_name": "COVID-19 At-Home Test Kit In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917012204",
      "ndc_label_name": "COVID-19 At-Home Test Kit In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60004041780",
      "ndc_label_name": "COVID-19 Testing by Pharmacist Kit",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00032121201",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 12000-38000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00032121207",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 12000-38000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00032004770",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 12000-38000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00032122401",
      "ndc_label_name": "Creon CAPSULE DELAYED RELEASE PARTICLES 24000-76000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00032263601",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 24000-76000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00032122407",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 24000-76000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00032120370",
      "ndc_label_name": "Creon CAPSULE DELAYED RELEASE PARTICLES 3000-9500 UNIT ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00032004570",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 3000-9500 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00032301628",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 36000-114000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00032301613",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 36000-114000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00032263701",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 36000-114000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00032004670",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 6000-19000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00032120607",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 6000-19000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00032120601",
      "ndc_label_name": "Creon Capsule Delayed Release Particles 6000-19000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006057143",
      "ndc_label_name": "Crixivan Capsule 200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006057362",
      "ndc_label_name": "Crixivan Capsule 400 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49614021160",
      "ndc_label_name": "Cromolyn Sodium Aerosol Solution 5.2 MG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57782039726",
      "ndc_label_name": "Cromolyn Sodium Aerosol Solution 5.2 MG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "48102003312",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543045612",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172640649",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571035009",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69784020530",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48102003360",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204002812",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69784020560",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162230706",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543045660",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204002860",
      "ndc_label_name": "Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999072010",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478029111",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314023710",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090304200",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090120200",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090312500",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788849001",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205023010",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205008510",
      "ndc_label_name": "Cromolyn Sodium Solution 4 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00682005130",
      "ndc_label_name": "Crotan Lotion 10 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00682005110",
      "ndc_label_name": "Crotan Lotion 10 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00682005120",
      "ndc_label_name": "Crotan Lotion 10 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555904958",
      "ndc_label_name": "Cryselle-28 Tablet 0.3-30 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356037028",
      "ndc_label_name": "Cryselle-28 Tablet 0.3-30 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788403202",
      "ndc_label_name": "Cryselle-28 Tablet 0.3-30 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555904979",
      "ndc_label_name": "Cryselle-28 Tablet 0.3-30 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788844202",
      "ndc_label_name": "Cryselle-28 Tablet 0.3-30 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090218300",
      "ndc_label_name": "Cryselle-28 Tablet 0.3-30 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10040082004",
      "ndc_label_name": "Cue COVID-19 Test Cartridge In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10040082002",
      "ndc_label_name": "Cue COVID-19 Test Cartridge In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10040082003",
      "ndc_label_name": "Cue COVID-19 Test Cartridge In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10040082001",
      "ndc_label_name": "Cue Health Monitoring System In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69842087808",
      "ndc_label_name": "CVS Acetaminophen Ex St Liquid 500 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59779092306",
      "ndc_label_name": "CVS Allergy Relief Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59779092308",
      "ndc_label_name": "CVS Allergy Relief Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428034174",
      "ndc_label_name": "CVS Allergy Relief TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428031078",
      "ndc_label_name": "CVS Allergy Relief TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59779092312",
      "ndc_label_name": "CVS Allergy Relief TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59779092322",
      "ndc_label_name": "CVS Allergy Relief Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59779092351",
      "ndc_label_name": "CVS Allergy Relief Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428191659",
      "ndc_label_name": "CVS Antacid Supreme Suspension 400-135 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428046386",
      "ndc_label_name": "CVS Anti-Diarrheal SUSPENSION 262 MG/15ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428396138",
      "ndc_label_name": "CVS Aspirin Extra Strength TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69842051246",
      "ndc_label_name": "CVS Athletes Foot (Tolnaftate) Aerosol Powder 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428537845",
      "ndc_label_name": "CVS Calcium Carbonate/Vit D TABLET 500-125 MG-UNIT ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428025628",
      "ndc_label_name": "CVS Chewable Childrens Vitamin Tablet Chewable 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428381541",
      "ndc_label_name": "CVS Childrens Multivit/Extra C TABLET CHEWABLE ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59779018224",
      "ndc_label_name": "CVS Chocolate Laxative Pieces Tablet Chewable 15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428613836",
      "ndc_label_name": "CVS Chocolate Laxative Pieces TABLET CHEWABLE 15 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59779072928",
      "ndc_label_name": "CVS Cortisone Maximum Strength GEL 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428032111",
      "ndc_label_name": "CVS Daily Fiber Packet 58.6 % Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428346758",
      "ndc_label_name": "CVS Gummy Swirls TABLET CHEWABLE ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428124848",
      "ndc_label_name": "CVS Ibuprofen Jr TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428267637",
      "ndc_label_name": "CVS Infants Gas Relief SUSPENSION 20 MG/0.3ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428034166",
      "ndc_label_name": "CVS Motion Sickness Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428322867",
      "ndc_label_name": "CVS Non-Aspirin Headache PM TABLET 500-38 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50428026511",
      "ndc_label_name": "CVS One Daily Mens 50+ Adv TABLET Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428889924",
      "ndc_label_name": "CVS Prenatal Gummy TABLET CHEWABLE 0.4-113.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428015168",
      "ndc_label_name": "CVS Stool Softener CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428015169",
      "ndc_label_name": "CVS Stool Softener CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50428060633",
      "ndc_label_name": "CVS Stool Softener Capsule 50 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00143962010",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143961901",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143962001",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143961910",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143962125",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143962101",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517003125",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714016525",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517003225",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517003101",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714016501",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714030201",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680012105",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517013001",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517003201",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457039925",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021050201",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714060905",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714030210",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457040005",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710166301",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323004441",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150036425",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001054259",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680011210",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090270900",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714060901",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001064060",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710166407",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001064059",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323004400",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680011310",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680012130",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090622900",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323004444",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756063581",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288030002",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069000510",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001050959",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288030302",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069017101",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323004401",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457040031",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069017201",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288030110",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457039910",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001050960",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710166406",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710166307",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680012110",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680011225",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288030111",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288030301",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084001",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001054260",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288030391",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710166501",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288030392",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680011399",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420007525",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756063525",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069000501",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069017110",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069017210",
      "ndc_label_name": "Cyanocobalamin SOLUTION 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603065001",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084025",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603065025",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518273900",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710166505",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288030001",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288030230",
      "ndc_label_name": "Cyanocobalamin Solution 1000 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093342201",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735004",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342210",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735085",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342205",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735090",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735003",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735012",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735010",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735209",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735021",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735221",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735006",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735200",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735009",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904740161",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735015",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735281",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735081",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000701",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735089",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735212",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735060",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634052800",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735030",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135059510",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735210",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000727",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135059501",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135059505",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735260",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041510",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735215",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634052881",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735290",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041501",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000703",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000709",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000718",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356065307",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735230",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634052890",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000750",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291015418",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000706",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634052860",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078301",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051620",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440735285",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078310",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634052845",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291015427",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291015412",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634052885",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041519",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051640",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000710",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078350",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634052871",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291015445",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291015410",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356065301",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063091715",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356065315",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356065312",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051606",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051610",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051615",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051603",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291015430",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040011",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051604",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051612",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051609",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051642",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018380",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051682",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291015460",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316304",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051621",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051614",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051660",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264408",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018330",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291015490",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472701",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051690",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051695",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040050",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018353",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090273700",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090260501",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264404",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472707",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018321",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018345",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264400",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264409",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090286200",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264401",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264407",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472708",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018360",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090260508",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316307",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090402401",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090332901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316308",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090267800",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090571108",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353018392",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264403",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472702",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472904",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316309",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316302",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090571208",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040010",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264406",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472709",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472908",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090577200",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090372800",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316303",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436040003",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264402",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316301",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589500",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090571300",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589608",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472700",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090571101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436084601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316300",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316306",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589506",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589502",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436040103",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472703",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589700",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436084604",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316700",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090329000",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090686400",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004202",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472704",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436040102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817033250",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472200",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090571100",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436040002",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590000",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004214",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472706",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004225",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004210",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090571104",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090571102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436084603",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004260",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004221",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589501",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004245",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030821",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090571106",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090571103",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817033200",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092530",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004228",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589504",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030815",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429005260",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090571107",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589503",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817033210",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760088990",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004235",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589507",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746017710",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090571109",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268019111",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004215",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006515",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036621",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589508",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036604",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076730",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090571201",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436040101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004220",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001145",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036640",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436040001",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036690",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006520",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090571204",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004200",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004230",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629121101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006420",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436084602",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760088915",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006560",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589509",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059930",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004290",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019105",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006486",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004212",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006472",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006572",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268019115",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055811",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059990",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084607",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053710",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030830",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006590",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053730",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004204",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036615",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092520",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69336010511",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187034215",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348010809",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053790",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187015730",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004207",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076704",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092560",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518347408",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187034221",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059920",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001115",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081207",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004240",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076715",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055801",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006545",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187034230",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059921",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187034260",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629133902",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348010810",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760088904",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760088920",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335126604",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187034245",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092590",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187034290",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025130",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059915",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760088940",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053760",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335126605",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081212",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036620",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629121001",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025145",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059960",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006430",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629133901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335196203",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081260",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076720",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006445",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025174",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092515",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053715",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629133904",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335196206",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081290",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760088930",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816703",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025180",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746017706",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053786",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629133907",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335211005",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629120901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006490",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816706",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847402",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036609",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187015790",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019101",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335249206",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629133909",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053720",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816709",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847403",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076709",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081210",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019199",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335249207",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980065710",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053721",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863703",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847405",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076790",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898301",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006456",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266605",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518347409",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001130",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863709",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788859609",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006460",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025192",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025115",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001670",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518382801",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001190",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518063503",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863706",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006530",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816705",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788753606",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001692",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006572",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081215",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518063504",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512087210",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001100",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863702",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816702",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037930",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335211001",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081230",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518278800",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008202",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001160",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863705",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788859606",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037960",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335211004",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081245",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518278801",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008205",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001172",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008203",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518063509",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008015",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335211007",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081272",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518278806",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518063501",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081220",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518063502",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006315",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603031201",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266604",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629133905",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934044260",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518063508",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081221",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518278804",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934044215",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003682",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266607",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629133908",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006521",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518278802",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629133900",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518278805",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934044230",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003694",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037980",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629929701",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006560",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518278803",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629133903",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518341501",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335126603",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420001190",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093345",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980065701",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335108901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518315900",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629133906",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934044290",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335196207",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162135905",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980065750",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335108907",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518315901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629133910",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006515",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037953",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027110",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008010",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025153",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335196201",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934044210",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006440",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006520",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003690",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027115",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008060",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788753602",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335249204",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006590",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006491",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335108903",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003695",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001903",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003693",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847406",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335249205",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335108905",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025160",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335108904",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004603",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335126601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004604",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847409",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266600",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335249200",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544025170",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335108906",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004610",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335249201",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004612",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788859602",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042845",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788753603",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335211006",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282028360",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001653",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004660",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788859603",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162135901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037992",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788753609",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335211009",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282028390",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090745",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282028327",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084615",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189054530",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008007",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788859605",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335249203",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420001101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189054560",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008206",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003645",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603031203",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69512054110",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335249209",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003302",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084100",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518063506",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420001120",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003698",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008201",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266609",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003320",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420001102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084110",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518278807",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420001130",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420001160",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008204",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162135900",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003390",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003307",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084160",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518370203",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003301",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027120",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518063505",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008020",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083030",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083000",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084190",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006330",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003330",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083005",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518278808",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008030",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083012",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006530",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027107",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509101409",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518278809",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008072",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084105",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509141503",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518335600",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205020172",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027130",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189054515",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518335601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335126606",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001902",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003615",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518341500",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335126607",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027160",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518382800",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335211000",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084120",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003660",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006320",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335211003",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049801",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789015615",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934044220",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266603",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425054701",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018809",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006510",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266606",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82461071690",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888001400",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335108909",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509101403",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888001405",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71550010101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189054590",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509141509",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003360",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001645",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603031202",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037945",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027190",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008090",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004606",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003621",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084130",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004620",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004614",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001801",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888001401",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004640",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282028310",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001802",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420001107",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282028318",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083001",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049802",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083060",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282028330",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083090",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049803",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001803",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027112",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509141506",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425054702",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425054703",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420084107",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509101406",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000601",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135059401",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041301",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090276100",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904740004",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904740006",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000650",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342001",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000610",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078210",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041319",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090276101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078201",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049414",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049415",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078250",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049421",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049410",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049430",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090525600",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300041305",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039910",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049420",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356084700",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049482",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049495",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325302",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700069690",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049401",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039950",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090276102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436000603",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817033050",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999079121",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268019015",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746021110",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049460",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999079100",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090575604",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436980503",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700000418",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325300",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084615",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036530",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325301",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090575600",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084600",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700069618",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268019011",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036515",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036590",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090575602",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090575601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746021106",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084610",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436000601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788744503",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090575603",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436000605",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076604",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084621",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092618",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436000604",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822108",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090115",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436980401",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436980402",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076615",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700069601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760053615",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084660",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518019100",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090130",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436980502",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436980403",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919054490",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700069630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919054420",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084690",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518325103",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187009410",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084620",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436980501",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090160",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919054430",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919054460",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012801",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187009415",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092690",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817033010",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187038010",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092660",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090190",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090182",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335196101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187009440",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429087601",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084640",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187038030",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429087605",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187038060",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071046290",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335196107",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980065510",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036504",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084642",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071046230",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760053604",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980065501",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518261101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335215602",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019001",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030560",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084645",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788713100",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760053690",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084075311",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934066730",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335215605",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084075325",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030590",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700069660",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788713105",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076690",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788744506",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205035621",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335215608",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788713103",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187009430",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760053630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788713109",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090120",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822109",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012800",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335247901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822103",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629121201",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030530",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788744508",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187009460",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870609",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109903",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335247902",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822106",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788713102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629242401",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518325101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629121301",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205035630",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335196105",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335247907",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847109",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980065550",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012809",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847106",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205035690",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335215609",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028090",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870608",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847103",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071046214",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870602",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012803",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162169200",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028360",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69336010411",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847108",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071046260",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092107",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518019103",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092103",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028315",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789011520",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518019101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870603",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084075365",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109909",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518261102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335196104",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028390",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003012",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012802",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870606",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084075395",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789054721",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205035660",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603031001",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003001",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003090",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012807",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084507",
      "ndc_label_name": "Cyclobenzaprine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788713101",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026915",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109902",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603031002",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003030",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026910",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012808",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518019102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788713106",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026930",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109907",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888001200",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082800",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026960",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518325102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788744509",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083900",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335196109",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003005",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082805",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082812",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335196102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205035640",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822102",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028082",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026907",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001701",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082830",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335196103",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092109",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518325100",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083907",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028320",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082801",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934022130",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083960",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335215601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205035615",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001603",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026901",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082890",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067860",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015501",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335215607",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109908",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109905",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015502",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007330",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083902",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162135805",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015504",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888001201",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162135801",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028030",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083920",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003060",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028015",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083905",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083930",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026902",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028060",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001602",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083990",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420082860",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028330",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083910",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028382",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789011510",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888001205",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026920",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026990",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001601",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001604",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015503",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015505",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82461071490",
      "ndc_label_name": "Cyclobenzaprine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071153105",
      "ndc_label_name": "Cyclopentolate HCl SOLUTION 1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61314039601",
      "ndc_label_name": "Cyclopentolate HCl SOLUTION 1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478010002",
      "ndc_label_name": "Cyclopentolate HCl Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478010012",
      "ndc_label_name": "Cyclopentolate HCl Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61314039603",
      "ndc_label_name": "Cyclopentolate HCl SOLUTION 1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24208073501",
      "ndc_label_name": "Cyclopentolate HCl SOLUTION 1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24208073506",
      "ndc_label_name": "Cyclopentolate HCl Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090323401",
      "ndc_label_name": "Cyclopentolate HCl Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54879002101",
      "ndc_label_name": "Cyclophosphamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332061831",
      "ndc_label_name": "Cyclophosphamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097051607",
      "ndc_label_name": "Cyclophosphamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559093001",
      "ndc_label_name": "Cyclophosphamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054038225",
      "ndc_label_name": "Cyclophosphamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332061931",
      "ndc_label_name": "Cyclophosphamide Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097051707",
      "ndc_label_name": "Cyclophosphamide Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559093101",
      "ndc_label_name": "Cyclophosphamide Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054038325",
      "ndc_label_name": "Cyclophosphamide Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54879002201",
      "ndc_label_name": "Cyclophosphamide Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084092125",
      "ndc_label_name": "CycloSPORINE CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084092195",
      "ndc_label_name": "CycloSPORINE CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505013400",
      "ndc_label_name": "CycloSPORINE CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084087925",
      "ndc_label_name": "CycloSPORINE CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505013300",
      "ndc_label_name": "CycloSPORINE CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084087995",
      "ndc_label_name": "CycloSPORINE CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093901919",
      "ndc_label_name": "cycloSPORINE Modified Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505463103",
      "ndc_label_name": "cycloSPORINE Modified Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093574119",
      "ndc_label_name": "cycloSPORINE Modified Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093901965",
      "ndc_label_name": "cycloSPORINE Modified Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155083811",
      "ndc_label_name": "cycloSPORINE Modified Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093574165",
      "ndc_label_name": "cycloSPORINE Modified Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155083830",
      "ndc_label_name": "cycloSPORINE Modified Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527194947",
      "ndc_label_name": "Cyproheptadine HCl Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121078816",
      "ndc_label_name": "Cyproheptadine HCl Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980050448",
      "ndc_label_name": "Cyproheptadine HCl SYRUP 2 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135094947",
      "ndc_label_name": "Cyproheptadine HCl Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328004416",
      "ndc_label_name": "Cyproheptadine HCl Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328054416",
      "ndc_label_name": "Cyproheptadine HCl Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135094994",
      "ndc_label_name": "Cyproheptadine HCl Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657069716",
      "ndc_label_name": "Cyproheptadine HCl Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752018512",
      "ndc_label_name": "Cyproheptadine HCl Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752010112",
      "ndc_label_name": "Cyproheptadine HCl Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206502",
      "ndc_label_name": "Cyproheptadine HCl Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206504",
      "ndc_label_name": "Cyproheptadine HCl Syrup 2 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689081601",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135063801",
      "ndc_label_name": "Cyproheptadine HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380079508",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115175701",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571080510",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090549101",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135063810",
      "ndc_label_name": "Cyproheptadine HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291022510",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090612901",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155070301",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335296401",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440736030",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689081610",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817021010",
      "ndc_label_name": "Cyproheptadine HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135023690",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999049318",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268018915",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291022501",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268018911",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571080501",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50488500202",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367024610",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268020111",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50488500201",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742019010",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268020115",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991083810",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742019001",
      "ndc_label_name": "Cyproheptadine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518241400",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098960",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629206201",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991083801",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752010710",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098978",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380079506",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407027201",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098900",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206600",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710111001",
      "ndc_label_name": "Cyproheptadine HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367024601",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098911",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206601",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002430",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407027210",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098972",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710111000",
      "ndc_label_name": "Cyproheptadine HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335075801",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817021050",
      "ndc_label_name": "Cyproheptadine HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098964",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752010711",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098967",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098930",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098976",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098990",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010230",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206602",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385013001",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206609",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010201",
      "ndc_label_name": "Cyproheptadine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11845016238",
      "ndc_label_name": "D 10000 Capsule 250 MCG (10000 UT) Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00087086604",
      "ndc_label_name": "D-Vi-Sol Liquid 10 MCG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090704400",
      "ndc_label_name": "D-Vi-Sol Liquid 10 MCG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00087086644",
      "ndc_label_name": "D-Vi-Sol Liquid 10 MCG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40985027415",
      "ndc_label_name": "D3-1000 Capsule 25 MCG (1000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "74312015605",
      "ndc_label_name": "D3-1000 Capsule 25 MCG (1000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53191036201",
      "ndc_label_name": "D3-50 Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090170000",
      "ndc_label_name": "D3-50 Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53191036212",
      "ndc_label_name": "D3-50 Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53191048901",
      "ndc_label_name": "D3-50 Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00591253360",
      "ndc_label_name": "Dalfampridine ER Tablet Extended Release 12 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756042986",
      "ndc_label_name": "Dalfampridine ER Tablet Extended Release 12 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729029212",
      "ndc_label_name": "Dalfampridine ER Tablet Extended Release 12 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378050991",
      "ndc_label_name": "Dalfampridine ER Tablet Extended Release 12 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054047921",
      "ndc_label_name": "Dalfampridine ER Tablet Extended Release 12 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877044460",
      "ndc_label_name": "Dalfampridine ER Tablet Extended Release 12 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407024660",
      "ndc_label_name": "Dalfampridine ER Tablet Extended Release 12 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407087660",
      "ndc_label_name": "Dalfampridine ER Tablet Extended Release 12 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571027560",
      "ndc_label_name": "Dalfampridine ER Tablet Extended Release 12 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629945001",
      "ndc_label_name": "Dalfampridine ER Tablet Extended Release 12 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862086360",
      "ndc_label_name": "Dalfampridine ER Tablet Extended Release 12 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162245906",
      "ndc_label_name": "Dalfampridine ER Tablet Extended Release 12 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82249070260",
      "ndc_label_name": "Dalfampridine ER Tablet Extended Release 12 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629325301",
      "ndc_label_name": "Dapagliflozin Propanediol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993045730",
      "ndc_label_name": "Dapagliflozin Propanediol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090705700",
      "ndc_label_name": "Dapagliflozin Propanediol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090705600",
      "ndc_label_name": "Dapagliflozin Propanediol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993045630",
      "ndc_label_name": "Dapagliflozin Propanediol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980056601",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13925050501",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135065530",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135096630",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022330",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13925050530",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135065501",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098900",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367041030",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033003730",
      "ndc_label_name": "Dapsone TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037901",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980056603",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037930",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954013610",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49938010101",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098911",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098960",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954013620",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49938010130",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367041001",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098972",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098990",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429049630",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098930",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098955",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098964",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098978",
      "ndc_label_name": "Dapsone Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367040901",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022230",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135065401",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49938010230",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135065430",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13925050430",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13925050401",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098811",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367040930",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098864",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033003601",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980056701",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033003630",
      "ndc_label_name": "Dapsone TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429049530",
      "ndc_label_name": "Dapsone TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037830",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954013510",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291000801",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098890",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037801",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098800",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49938010201",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980056703",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954013520",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098860",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135096530",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73190003701",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098830",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098872",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098855",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098878",
      "ndc_label_name": "Dapsone Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281028658",
      "ndc_label_name": "Daptacel Suspension 23-15-5 Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281028610",
      "ndc_label_name": "Daptacel Suspension 23-15-5 Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49614032930",
      "ndc_label_name": "Day-Time Cold/Flu Relief Liquid 10-5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40986003147",
      "ndc_label_name": "Daytime Sinus Congestion CAPSULE 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59651044877",
      "ndc_label_name": "Deferasirox Granules Packet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651044830",
      "ndc_label_name": "Deferasirox Granules Packet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591473530",
      "ndc_label_name": "Deferasirox Granules Packet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877067684",
      "ndc_label_name": "Deferasirox Granules Packet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591474030",
      "ndc_label_name": "Deferasirox Granules Packet 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877067784",
      "ndc_label_name": "Deferasirox Granules Packet 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651044930",
      "ndc_label_name": "Deferasirox Granules Packet 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651044954",
      "ndc_label_name": "Deferasirox Granules Packet 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877067584",
      "ndc_label_name": "Deferasirox Granules Packet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591473030",
      "ndc_label_name": "Deferasirox Granules Packet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651044738",
      "ndc_label_name": "Deferasirox Granules Packet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651044730",
      "ndc_label_name": "Deferasirox Granules Packet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097039202",
      "ndc_label_name": "Deferasirox Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700027030",
      "ndc_label_name": "Deferasirox Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714099401",
      "ndc_label_name": "Deferasirox Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651041130",
      "ndc_label_name": "Deferasirox Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332041130",
      "ndc_label_name": "Deferasirox Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722001230",
      "ndc_label_name": "Deferasirox Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710127603",
      "ndc_label_name": "Deferasirox Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598085230",
      "ndc_label_name": "Deferasirox Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603023201",
      "ndc_label_name": "Deferasirox Tablet 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714099501",
      "ndc_label_name": "Deferasirox Tablet 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651041230",
      "ndc_label_name": "Deferasirox Tablet 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598085130",
      "ndc_label_name": "Deferasirox Tablet 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722001330",
      "ndc_label_name": "Deferasirox Tablet 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097039302",
      "ndc_label_name": "Deferasirox Tablet 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877055430",
      "ndc_label_name": "Deferasirox Tablet 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603023301",
      "ndc_label_name": "Deferasirox Tablet 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73190005230",
      "ndc_label_name": "Deferasirox Tablet 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332041230",
      "ndc_label_name": "Deferasirox Tablet 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700027130",
      "ndc_label_name": "Deferasirox Tablet 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710127703",
      "ndc_label_name": "Deferasirox Tablet 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722001130",
      "ndc_label_name": "Deferasirox Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651041030",
      "ndc_label_name": "Deferasirox Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877055230",
      "ndc_label_name": "Deferasirox Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714099301",
      "ndc_label_name": "Deferasirox Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598085330",
      "ndc_label_name": "Deferasirox Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710127503",
      "ndc_label_name": "Deferasirox Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097039102",
      "ndc_label_name": "Deferasirox Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603023101",
      "ndc_label_name": "Deferasirox Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332041030",
      "ndc_label_name": "Deferasirox Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700026930",
      "ndc_label_name": "Deferasirox Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598085530",
      "ndc_label_name": "Deferasirox Tablet Soluble 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480701156",
      "ndc_label_name": "Deferasirox Tablet Soluble 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756056883",
      "ndc_label_name": "Deferasirox Tablet Soluble 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332032430",
      "ndc_label_name": "Deferasirox Tablet Soluble 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963045430",
      "ndc_label_name": "Deferasirox Tablet Soluble 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877054930",
      "ndc_label_name": "Deferasirox Tablet Soluble 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462049430",
      "ndc_label_name": "Deferasirox Tablet Soluble 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452015913",
      "ndc_label_name": "Deferasirox Tablet Soluble 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756056983",
      "ndc_label_name": "Deferasirox Tablet Soluble 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480701256",
      "ndc_label_name": "Deferasirox Tablet Soluble 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598085630",
      "ndc_label_name": "Deferasirox Tablet Soluble 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332032530",
      "ndc_label_name": "Deferasirox Tablet Soluble 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877055030",
      "ndc_label_name": "Deferasirox Tablet Soluble 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963045530",
      "ndc_label_name": "Deferasirox Tablet Soluble 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462049530",
      "ndc_label_name": "Deferasirox Tablet Soluble 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452016013",
      "ndc_label_name": "Deferasirox Tablet Soluble 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598085430",
      "ndc_label_name": "Deferasirox Tablet Soluble 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963045630",
      "ndc_label_name": "Deferasirox Tablet Soluble 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756057083",
      "ndc_label_name": "Deferasirox Tablet Soluble 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480701356",
      "ndc_label_name": "Deferasirox Tablet Soluble 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877055130",
      "ndc_label_name": "Deferasirox Tablet Soluble 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332032630",
      "ndc_label_name": "Deferasirox Tablet Soluble 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462049630",
      "ndc_label_name": "Deferasirox Tablet Soluble 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452016113",
      "ndc_label_name": "Deferasirox Tablet Soluble 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054071119",
      "ndc_label_name": "Deferiprone Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672423704",
      "ndc_label_name": "Deferiprone Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907034850",
      "ndc_label_name": "Deferiprone Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907034901",
      "ndc_label_name": "Deferiprone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054057625",
      "ndc_label_name": "Deferiprone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672419601",
      "ndc_label_name": "Deferiprone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006500701",
      "ndc_label_name": "Delstrigo Tablet 100-300-300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074611413",
      "ndc_label_name": "Depakote Sprinkles Capsule Delayed Release Sprinkle 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999094230",
      "ndc_label_name": "Depakote Sprinkles Capsule Delayed Release Sprinkle 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00037440101",
      "ndc_label_name": "Depen Titratabs Tablet 250 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009307322",
      "ndc_label_name": "Depo-Medrol SUSPENSION 40 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009028052",
      "ndc_label_name": "Depo-Medrol SUSPENSION 40 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009028051",
      "ndc_label_name": "Depo-Medrol SUSPENSION 40 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009307323",
      "ndc_label_name": "Depo-Medrol SUSPENSION 40 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009028003",
      "ndc_label_name": "Depo-Medrol SUSPENSION 40 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009307303",
      "ndc_label_name": "Depo-Medrol SUSPENSION 40 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009028002",
      "ndc_label_name": "Depo-Medrol SUSPENSION 40 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009307301",
      "ndc_label_name": "Depo-Medrol SUSPENSION 40 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090209800",
      "ndc_label_name": "Depo-Medrol Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090031201",
      "ndc_label_name": "Depo-Medrol Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090055600",
      "ndc_label_name": "Depo-Medrol Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090043600",
      "ndc_label_name": "Depo-Medrol Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009347501",
      "ndc_label_name": "Depo-Medrol SUSPENSION 80 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009347522",
      "ndc_label_name": "DEPO-Medrol Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009030602",
      "ndc_label_name": "Depo-Medrol SUSPENSION 80 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009347503",
      "ndc_label_name": "Depo-Medrol SUSPENSION 80 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420008101",
      "ndc_label_name": "DEPO-Medrol Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090182300",
      "ndc_label_name": "Depo-Medrol Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009030612",
      "ndc_label_name": "Depo-Medrol SUSPENSION 80 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009347523",
      "ndc_label_name": "DEPO-Medrol Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009034702",
      "ndc_label_name": "Depo-Testosterone Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009008510",
      "ndc_label_name": "Depo-Testosterone Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009008610",
      "ndc_label_name": "Depo-Testosterone Solution 200 MG/ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009008601",
      "ndc_label_name": "Depo-Testosterone Solution 200 MG/ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009041702",
      "ndc_label_name": "Depo-Testosterone Solution 200 MG/ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009041701",
      "ndc_label_name": "Depo-Testosterone Solution 200 MG/ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61958200501",
      "ndc_label_name": "Descovy Tablet 120-15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958200201",
      "ndc_label_name": "Descovy TABLET 200-25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958200202",
      "ndc_label_name": "Descovy Tablet 200-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518023000",
      "ndc_label_name": "Descovy Tablet 200-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039130",
      "ndc_label_name": "Desipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155057801",
      "ndc_label_name": "Desipramine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781821801",
      "ndc_label_name": "Desipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012830",
      "ndc_label_name": "Desipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012860",
      "ndc_label_name": "Desipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963034102",
      "ndc_label_name": "Desipramine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135059312",
      "ndc_label_name": "Desipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742011201",
      "ndc_label_name": "Desipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629759601",
      "ndc_label_name": "Desipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332031531",
      "ndc_label_name": "Desipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189010430",
      "ndc_label_name": "Desipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238105301",
      "ndc_label_name": "Desipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332031931",
      "ndc_label_name": "Desipramine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781897501",
      "ndc_label_name": "Desipramine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135059830",
      "ndc_label_name": "Desipramine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742011601",
      "ndc_label_name": "Desipramine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238106101",
      "ndc_label_name": "Desipramine HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155058201",
      "ndc_label_name": "Desipramine HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963034502",
      "ndc_label_name": "Desipramine HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267062630",
      "ndc_label_name": "Desipramine HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963034650",
      "ndc_label_name": "Desipramine HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742011750",
      "ndc_label_name": "Desipramine HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781897650",
      "ndc_label_name": "Desipramine HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155058325",
      "ndc_label_name": "Desipramine HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238106302",
      "ndc_label_name": "Desipramine HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135059930",
      "ndc_label_name": "Desipramine HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332032050",
      "ndc_label_name": "Desipramine HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781897201",
      "ndc_label_name": "Desipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045814",
      "ndc_label_name": "Desipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356038530",
      "ndc_label_name": "Desipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155057901",
      "ndc_label_name": "Desipramine HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135059412",
      "ndc_label_name": "Desipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332031631",
      "ndc_label_name": "Desipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963034202",
      "ndc_label_name": "Desipramine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045821",
      "ndc_label_name": "Desipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742011301",
      "ndc_label_name": "Desipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238105501",
      "ndc_label_name": "Desipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045860",
      "ndc_label_name": "Desipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045820",
      "ndc_label_name": "Desipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959046420",
      "ndc_label_name": "Desipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959046412",
      "ndc_label_name": "Desipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155058001",
      "ndc_label_name": "Desipramine HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959046400",
      "ndc_label_name": "Desipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781897301",
      "ndc_label_name": "Desipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963034302",
      "ndc_label_name": "Desipramine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775009",
      "ndc_label_name": "Desipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332031731",
      "ndc_label_name": "Desipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959046414",
      "ndc_label_name": "Desipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742011401",
      "ndc_label_name": "Desipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135059512",
      "ndc_label_name": "Desipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775003",
      "ndc_label_name": "Desipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775001",
      "ndc_label_name": "Desipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238105701",
      "ndc_label_name": "Desipramine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775006",
      "ndc_label_name": "Desipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742011501",
      "ndc_label_name": "Desipramine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963034402",
      "ndc_label_name": "Desipramine HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135059712",
      "ndc_label_name": "Desipramine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781897401",
      "ndc_label_name": "Desipramine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332031831",
      "ndc_label_name": "Desipramine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155058101",
      "ndc_label_name": "Desipramine HCl TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238105901",
      "ndc_label_name": "Desipramine HCl TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24208034205",
      "ndc_label_name": "Desmopressin Ace Spray Refrig SOLUTION 0.01 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756016191",
      "ndc_label_name": "Desmopressin Ace Spray Refrig SOLUTION 0.01 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682034205",
      "ndc_label_name": "Desmopressin Ace Spray Refrig Solution 0.01 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73177011415",
      "ndc_label_name": "Desmopressin Acetate Solution 1.5 MG/ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382038401",
      "ndc_label_name": "Desmopressin Acetate Spray Solution 0.01 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918050105",
      "ndc_label_name": "Desmopressin Acetate Spray Solution 0.01 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162212902",
      "ndc_label_name": "Desmopressin Acetate Spray Solution 0.01 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335078891",
      "ndc_label_name": "Desmopressin Acetate Spray Solution 0.01 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505081500",
      "ndc_label_name": "Desmopressin Acetate Spray Solution 0.01 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084060611",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737160",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505025701",
      "ndc_label_name": "Desmopressin Acetate TABLET 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072121",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591246401",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462027501",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714088301",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702016901",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072111",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001057400",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69918010101",
      "ndc_label_name": "Desmopressin Acetate TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268022015",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155048901",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518314800",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268022011",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084060621",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651024901",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001032500",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518314801",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268022111",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702017001",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073211",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591246501",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356015590",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737260",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714088401",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356015530",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001057500",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155049001",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162210101",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073221",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084060411",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268022115",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518312501",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001032600",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651025001",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69918020101",
      "ndc_label_name": "Desmopressin Acetate TABLET 0.2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084060421",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462027601",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505025801",
      "ndc_label_name": "Desmopressin Acetate TABLET 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518312500",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518314900",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518314901",
      "ndc_label_name": "Desmopressin Acetate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378729653",
      "ndc_label_name": "Desogestrel-Ethinyl Estradiol TABLET 0.15-0.02/0.01 MG (21/5) ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629244901",
      "ndc_label_name": "Desogestrel-Ethinyl Estradiol Tablet 0.15-0.02/0.01 MG (21/5) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713066115",
      "ndc_label_name": "Desonide CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462025265",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472080415",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672128001",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802042235",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714072901",
      "ndc_label_name": "Desonide CREAM 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802042237",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332063260",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332063215",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714072902",
      "ndc_label_name": "Desonide CREAM 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472080460",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629250701",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672128003",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462025217",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436330001",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425037101",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187074715",
      "ndc_label_name": "Desonide CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162200506",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713066160",
      "ndc_label_name": "Desonide CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578008601",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578008602",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041801",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629250601",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162200502",
      "ndc_label_name": "Desonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462052865",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462052817",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922000404",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168030915",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629848201",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672128103",
      "ndc_label_name": "Desonide OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714082802",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168030960",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162232902",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332048560",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922000407",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748047015",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802042337",
      "ndc_label_name": "Desonide OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162127202",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748047060",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714082801",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672128101",
      "ndc_label_name": "Desonide OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603016402",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332048515",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802042335",
      "ndc_label_name": "Desonide OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629848101",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603016401",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162127206",
      "ndc_label_name": "Desonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432046608",
      "ndc_label_name": "Dexamethasone Elixir 0.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85742000403",
      "ndc_label_name": "Dexamethasone Elixir 0.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54879000308",
      "ndc_label_name": "Dexamethasone Elixir 0.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980050924",
      "ndc_label_name": "Dexamethasone ELIXIR 0.5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135011437",
      "ndc_label_name": "Dexamethasone Elixir 0.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954087210",
      "ndc_label_name": "Dexamethasone Elixir 0.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162260002",
      "ndc_label_name": "Dexamethasone Elixir 0.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76045021010",
      "ndc_label_name": "dexAMETHasone Sod Phos +RFID Solution Prefilled Syringe 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045021000",
      "ndc_label_name": "dexAMETHasone Sod Phos +RFID Solution Prefilled Syringe 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208072002",
      "ndc_label_name": "Dexamethasone Sodium Phosphate SOLUTION 0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518041000",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959028803",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518293601",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016501",
      "ndc_label_name": "Dexamethasone Sodium Phosphate SOLUTION 4 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641614501",
      "ndc_label_name": "Dexamethasone Sodium Phosphate SOLUTION 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641614525",
      "ndc_label_name": "Dexamethasone Sodium Phosphate SOLUTION 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090192200",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457042300",
      "ndc_label_name": "Dexamethasone Sodium Phosphate SOLUTION 4 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090192201",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457041901",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572012025",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457042312",
      "ndc_label_name": "Dexamethasone Sodium Phosphate SOLUTION 4 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021005201",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016516",
      "ndc_label_name": "Dexamethasone Sodium Phosphate SOLUTION 4 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457041900",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518147400",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023701",
      "ndc_label_name": "Dexamethasone Sodium Phosphate SOLUTION 4 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572012001",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518301901",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81565020202",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154936405",
      "ndc_label_name": "Dexamethasone Sodium Phosphate SOLUTION 4 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518147401",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518293600",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81565020201",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016502",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518301900",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266105002",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266105102",
      "ndc_label_name": "Dexamethasone Sodium Phosphate Solution 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045010610",
      "ndc_label_name": "dexAMETHasone Sodium Phosphate Solution Prefilled Syringe 4 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054317763",
      "ndc_label_name": "Dexamethasone SOLUTION 0.5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054317757",
      "ndc_label_name": "Dexamethasone SOLUTION 0.5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954039810",
      "ndc_label_name": "dexAMETHasone Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054417925",
      "ndc_label_name": "dexAMETHasone Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578016801",
      "ndc_label_name": "dexAMETHasone Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054817925",
      "ndc_label_name": "dexAMETHasone Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888023501",
      "ndc_label_name": "dexAMETHasone Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505624901",
      "ndc_label_name": "dexAMETHasone Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603021201",
      "ndc_label_name": "dexAMETHasone Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959039221",
      "ndc_label_name": "Dexamethasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959039228",
      "ndc_label_name": "Dexamethasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726702",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726703",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054818025",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959039201",
      "ndc_label_name": "Dexamethasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054418025",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876300",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954039910",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006630",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876301",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959039212",
      "ndc_label_name": "Dexamethasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505625001",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959039230",
      "ndc_label_name": "Dexamethasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289090312",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289090310",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603021301",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006612",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189038330",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726700",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726701",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876303",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289090320",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876302",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888023601",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578016901",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629412904",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789050120",
      "ndc_label_name": "dexAMETHasone Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578016601",
      "ndc_label_name": "dexAMETHasone Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054418125",
      "ndc_label_name": "dexAMETHasone Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888023701",
      "ndc_label_name": "dexAMETHasone Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505625101",
      "ndc_label_name": "dexAMETHasone Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054817425",
      "ndc_label_name": "dexAMETHasone Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356035930",
      "ndc_label_name": "dexAMETHasone Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054418225",
      "ndc_label_name": "Dexamethasone TABLET 1.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054818125",
      "ndc_label_name": "Dexamethasone TABLET 1.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42195015110",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425034604",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629412702",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505625201",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082715",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189046821",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888023801",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919026955",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68047070201",
      "ndc_label_name": "Dexamethasone TABLET 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578017001",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189057221",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919026921",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954040110",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603018701",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189046815",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629412703",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425034603",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082721",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013221",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70868092021",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189057215",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425034601",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425034602",
      "ndc_label_name": "Dexamethasone Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054817625",
      "ndc_label_name": "Dexamethasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687077301",
      "ndc_label_name": "Dexamethasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505625301",
      "ndc_label_name": "Dexamethasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054418325",
      "ndc_label_name": "Dexamethasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219205601",
      "ndc_label_name": "Dexamethasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687077311",
      "ndc_label_name": "Dexamethasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904744461",
      "ndc_label_name": "Dexamethasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888023901",
      "ndc_label_name": "dexAMETHasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452027620",
      "ndc_label_name": "Dexamethasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954040210",
      "ndc_label_name": "Dexamethasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603018801",
      "ndc_label_name": "Dexamethasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187038305",
      "ndc_label_name": "Dexamethasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063026607",
      "ndc_label_name": "Dexamethasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189052308",
      "ndc_label_name": "Dexamethasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305000",
      "ndc_label_name": "Dexamethasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578016701",
      "ndc_label_name": "Dexamethasone Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054817525",
      "ndc_label_name": "Dexamethasone TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904726661",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48102004701",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054711",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054418425",
      "ndc_label_name": "Dexamethasone TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48102004720",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090008804",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "48102005101",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781091401",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291015501",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054710",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822301",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781091413",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054716",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219204301",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999005906",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090615104",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090008900",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054750",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846701",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781091451",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687071801",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687071811",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407036101",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090615200",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054720",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289058210",
      "ndc_label_name": "Dexamethasone TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846706",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999005912",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187056115",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629374201",
      "ndc_label_name": "Dexamethasone TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289058204",
      "ndc_label_name": "Dexamethasone TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054704",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154490100",
      "ndc_label_name": "Dexamethasone TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289058221",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876505",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054712",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006704",
      "ndc_label_name": "Dexamethasone TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006708",
      "ndc_label_name": "Dexamethasone TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289058215",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054730",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289058228",
      "ndc_label_name": "Dexamethasone TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505625401",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205070320",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187056110",
      "ndc_label_name": "Dexamethasone TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882401",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006720",
      "ndc_label_name": "Dexamethasone TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629374209",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289058206",
      "ndc_label_name": "Dexamethasone TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700096112",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67296032601",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789053495",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629374202",
      "ndc_label_name": "Dexamethasone TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882406",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788714201",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993073051",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993073002",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006710",
      "ndc_label_name": "Dexamethasone TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788714205",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032801",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629374203",
      "ndc_label_name": "Dexamethasone TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578017101",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822305",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822306",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788714203",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804015704",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425051501",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876501",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993073080",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804015720",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846705",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822303",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804025415",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846703",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876503",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882403",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876506",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189051110",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882405",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452027720",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518153400",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789053401",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789053428",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954040310",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888024001",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189025410",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603018901",
      "ndc_label_name": "Dexamethasone Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054818325",
      "ndc_label_name": "Dexamethasone TABLET 6 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072901",
      "ndc_label_name": "Dexamethasone Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219204401",
      "ndc_label_name": "Dexamethasone Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788829301",
      "ndc_label_name": "Dexamethasone Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452027820",
      "ndc_label_name": "Dexamethasone Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054418625",
      "ndc_label_name": "Dexamethasone TABLET 6 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904726761",
      "ndc_label_name": "Dexamethasone Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578017201",
      "ndc_label_name": "Dexamethasone Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603019001",
      "ndc_label_name": "Dexamethasone Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781091601",
      "ndc_label_name": "Dexamethasone Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888024101",
      "ndc_label_name": "dexAMETHasone Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518299800",
      "ndc_label_name": "Dexamethasone Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505625501",
      "ndc_label_name": "Dexamethasone Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072911",
      "ndc_label_name": "Dexamethasone Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954040410",
      "ndc_label_name": "Dexamethasone Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08627005104",
      "ndc_label_name": "Dexcom G5 Mob/G4 Plat Sensor",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08627001401",
      "ndc_label_name": "Dexcom G5 Mobile Transmitter",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08627009111",
      "ndc_label_name": "Dexcom G6 Receiver Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08627005303",
      "ndc_label_name": "Dexcom G6 Sensor",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08627001601",
      "ndc_label_name": "Dexcom G6 Transmitter",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08627007901",
      "ndc_label_name": "Dexcom G7 15 Day Sensor",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090791600",
      "ndc_label_name": "Dexcom G7 15 Day Sensor",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08627007801",
      "ndc_label_name": "Dexcom G7 Receiver Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08627007701",
      "ndc_label_name": "Dexcom G7 Sensor",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702010801",
      "ndc_label_name": "Dexmethylphenidate HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858041001",
      "ndc_label_name": "Dexmethylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808009301",
      "ndc_label_name": "Dexmethylphenidate HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877065701",
      "ndc_label_name": "Dexmethylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664037988",
      "ndc_label_name": "Dexmethylphenidate HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162128601",
      "ndc_label_name": "Dexmethylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629230701",
      "ndc_label_name": "Dexmethylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242701",
      "ndc_label_name": "Dexmethylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629946701",
      "ndc_label_name": "Dexmethylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834032801",
      "ndc_label_name": "Dexmethylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629230601",
      "ndc_label_name": "Dexmethylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162128501",
      "ndc_label_name": "Dexmethylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629946901",
      "ndc_label_name": "Dexmethylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808009201",
      "ndc_label_name": "Dexmethylphenidate HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242601",
      "ndc_label_name": "Dexmethylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702010701",
      "ndc_label_name": "Dexmethylphenidate HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858022501",
      "ndc_label_name": "Dexmethylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664037888",
      "ndc_label_name": "Dexmethylphenidate HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877065601",
      "ndc_label_name": "Dexmethylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834032701",
      "ndc_label_name": "Dexmethylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242606",
      "ndc_label_name": "Dexmethylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963030409",
      "ndc_label_name": "Dextroamphetamine Sulfate ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862034590",
      "ndc_label_name": "Dextroamphetamine Sulfate ER Capsule Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406896101",
      "ndc_label_name": "Dextroamphetamine Sulfate ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406896201",
      "ndc_label_name": "Dextroamphetamine Sulfate ER CAPSULE EXTENDED RELEASE 24 HOUR 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862034690",
      "ndc_label_name": "Dextroamphetamine Sulfate ER Capsule Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963030509",
      "ndc_label_name": "Dextroamphetamine Sulfate ER CAPSULE EXTENDED RELEASE 24 HOUR 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963030309",
      "ndc_label_name": "Dextroamphetamine Sulfate ER CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406896001",
      "ndc_label_name": "Dextroamphetamine Sulfate ER CAPSULE EXTENDED RELEASE 24 HOUR 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862034490",
      "ndc_label_name": "Dextroamphetamine Sulfate ER Capsule Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162235003",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702006606",
      "ndc_label_name": "Dextroamphetamine Sulfate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555095302",
      "ndc_label_name": "Dextroamphetamine Sulfate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237401",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702006603",
      "ndc_label_name": "Dextroamphetamine Sulfate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534018901",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895901",
      "ndc_label_name": "Dextroamphetamine Sulfate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702006601",
      "ndc_label_name": "Dextroamphetamine Sulfate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826012310",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536051001",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382094201",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107003601",
      "ndc_label_name": "Dextroamphetamine Sulfate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162123403",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536051003",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162123401",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406895801",
      "ndc_label_name": "Dextroamphetamine Sulfate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536050001",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534018801",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702006501",
      "ndc_label_name": "Dextroamphetamine Sulfate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237501",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555095202",
      "ndc_label_name": "Dextroamphetamine Sulfate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702006503",
      "ndc_label_name": "Dextroamphetamine Sulfate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107003501",
      "ndc_label_name": "Dextroamphetamine Sulfate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162234903",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382094101",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536050003",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162123301",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162123303",
      "ndc_label_name": "Dextroamphetamine Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739050501",
      "ndc_label_name": "Dextromethorphan-guaiFENesin Syrup 10-100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904713572",
      "ndc_label_name": "Dextromethorphan-guaiFENesin Syrup 10-100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090265700",
      "ndc_label_name": "Dextromethorphan-Guaifenesin Syrup 10-100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904751270",
      "ndc_label_name": "Dextromethorphan-guaiFENesin Syrup 10-100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629115501",
      "ndc_label_name": "Dextromethorphan-guaiFENesin Syrup 10-100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904751241",
      "ndc_label_name": "Dextromethorphan-guaiFENesin Syrup 10-100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58657050508",
      "ndc_label_name": "Dextromethorphan-guaiFENesin Syrup 10-100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904713470",
      "ndc_label_name": "Dextromethorphan-guaiFENesin Syrup 10-100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63739050510",
      "ndc_label_name": "Dextromethorphan-guaiFENesin Syrup 10-100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60687081740",
      "ndc_label_name": "Dextromethorphan-guaiFENesin Syrup 10-100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60687081717",
      "ndc_label_name": "Dextromethorphan-guaiFENesin Syrup 10-100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162167002",
      "ndc_label_name": "Dextromethorphan-guaiFENesin Syrup 10-100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43063080160",
      "ndc_label_name": "Dextromethorphan-Guaifenesin Tablet 20-400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43063080190",
      "ndc_label_name": "Dextromethorphan-Guaifenesin Tablet 20-400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43063080130",
      "ndc_label_name": "Dextromethorphan-Guaifenesin Tablet 20-400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54738098530",
      "ndc_label_name": "Dextromethorphan-Guaifenesin Tablet 20-400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "24689012301",
      "ndc_label_name": "Dextromethorphan-guaiFENesin Tablet 20-400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54738098560",
      "ndc_label_name": "Dextromethorphan-Guaifenesin TABLET 20-400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "24689012302",
      "ndc_label_name": "Dextromethorphan-guaiFENesin Tablet 20-400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00264775100",
      "ndc_label_name": "Dextrose in Lactated Ringers SOLUTION 5 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338012504",
      "ndc_label_name": "Dextrose in Lactated Ringers SOLUTION 5 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792909",
      "ndc_label_name": "Dextrose in Lactated Ringers Solution 5 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338012503",
      "ndc_label_name": "Dextrose in Lactated Ringers SOLUTION 5 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264775110",
      "ndc_label_name": "Dextrose in Lactated Ringers SOLUTION 5 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990792903",
      "ndc_label_name": "Dextrose in Lactated Ringers Solution 5 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11917009586",
      "ndc_label_name": "DHA Complete CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68682065220",
      "ndc_label_name": "diazePAM Gel 10 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386028001",
      "ndc_label_name": "diazePAM Gel 10 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710207902",
      "ndc_label_name": "diazePAM Gel 10 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162190002",
      "ndc_label_name": "diazePAM Gel 10 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682065020",
      "ndc_label_name": "diazePAM Gel 2.5 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710207802",
      "ndc_label_name": "diazePAM Gel 2.5 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386028101",
      "ndc_label_name": "diazePAM Gel 20 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682065520",
      "ndc_label_name": "diazePAM Gel 20 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710208002",
      "ndc_label_name": "diazePAM Gel 20 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054318544",
      "ndc_label_name": "Diazepam Intensol CONCENTRATE 5 MG/ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054318863",
      "ndc_label_name": "diazePAM Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135076745",
      "ndc_label_name": "diazePAM Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904711793",
      "ndc_label_name": "diazePAM Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121090505",
      "ndc_label_name": "diazePAM Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687075586",
      "ndc_label_name": "diazePAM Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135076724",
      "ndc_label_name": "diazePAM Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121090594",
      "ndc_label_name": "diazePAM Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904711741",
      "ndc_label_name": "diazePAM Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687075540",
      "ndc_label_name": "diazePAM Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135076747",
      "ndc_label_name": "diazePAM Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999076724",
      "ndc_label_name": "diazePAM Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094075062",
      "ndc_label_name": "diazePAM Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094075059",
      "ndc_label_name": "diazePAM Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999076745",
      "ndc_label_name": "diazePAM Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356081260",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737730",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098702",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027660",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378047701",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378047705",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172392760",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737760",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027675",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737793",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098760",
      "ndc_label_name": "DiazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027670",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356081290",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737791",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172392770",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027615",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959030602",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027630",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090172601",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002720",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862094310",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959030628",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172392780",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027645",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959030630",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090172600",
      "ndc_label_name": "DiazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862094301",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090172602",
      "ndc_label_name": "DiazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289009210",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959030660",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737790",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027653",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760092760",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090172603",
      "ndc_label_name": "DiazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862094305",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079028620",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289009240",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959030690",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098720",
      "ndc_label_name": "DiazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027680",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090660",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079028601",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289009206",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959030620",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289009290",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289009225",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098730",
      "ndc_label_name": "DiazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959030606",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187054420",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959030610",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118562006",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289009201",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187054406",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651065405",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959030600",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959030645",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187084606",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959030615",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037730",
      "ndc_label_name": "DiazePAM TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651065499",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006804",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013190",
      "ndc_label_name": "Diazepam TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289009298",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651065401",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152410",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289009202",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006801",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013160",
      "ndc_label_name": "DiazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006815",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090602",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013130",
      "ndc_label_name": "DiazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013102",
      "ndc_label_name": "DiazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006810",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289009220",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788920708",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090610",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006840",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090630",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135078890",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013110",
      "ndc_label_name": "Diazepam TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006820",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289009230",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518001400",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187084620",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788920701",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187084630",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006802",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788920703",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006878",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289009260",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335044403",
      "ndc_label_name": "DiazePAM TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846203",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335044402",
      "ndc_label_name": "DiazePAM TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006828",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518016200",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518016202",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788920702",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118562003",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335044404",
      "ndc_label_name": "DiazePAM TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788920700",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335044407",
      "ndc_label_name": "DiazePAM TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042715",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518016203",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042415",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788920705",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152402",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335044409",
      "ndc_label_name": "DiazePAM TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335044406",
      "ndc_label_name": "DiazePAM TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335044408",
      "ndc_label_name": "DiazePAM TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042770",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042753",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042445",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335044401",
      "ndc_label_name": "DiazePAM TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006845",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425051101",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335219602",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042430",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055260",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042760",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042453",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335230602",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006891",
      "ndc_label_name": "Diazepam TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425051102",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042470",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042460",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015102",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040005",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040030",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040060",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846202",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804018630",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042730",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425051202",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425051201",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012002",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055202",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788920704",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042745",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788920706",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055230",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788920709",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042780",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335044400",
      "ndc_label_name": "DiazePAM TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425051203",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335044405",
      "ndc_label_name": "DiazePAM TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425051103",
      "ndc_label_name": "diazePAM Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737530",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082070",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082560",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959025915",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028130",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959025910",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172392560",
      "ndc_label_name": "Diazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378027101",
      "ndc_label_name": "Diazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084030",
      "ndc_label_name": "DiazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090339006",
      "ndc_label_name": "DiazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079028420",
      "ndc_label_name": "Diazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959029550",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028153",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959029530",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172392570",
      "ndc_label_name": "Diazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028160",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028170",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267055012",
      "ndc_label_name": "Diazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862094105",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135078690",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082060",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651065201",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378027105",
      "ndc_label_name": "Diazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090339001",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082030",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267055030",
      "ndc_label_name": "Diazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651065205",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267055060",
      "ndc_label_name": "Diazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082553",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335224701",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082530",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046053",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082053",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046070",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862094101",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082570",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959029502",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090019501",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267055020",
      "ndc_label_name": "Diazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079028401",
      "ndc_label_name": "Diazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518185600",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090019506",
      "ndc_label_name": "DiazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700005890",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267055002",
      "ndc_label_name": "Diazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267055090",
      "ndc_label_name": "Diazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046030",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189019330",
      "ndc_label_name": "DiazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046060",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189057030",
      "ndc_label_name": "diazePAM Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071809",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172392670",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737606",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737630",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172392660",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027853",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378034501",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737603",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071890",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737691",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737660",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078315",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172392680",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078320",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071812",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737690",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027815",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071806",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027855",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078380",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378034505",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001830",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071815",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071810",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027820",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097004",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078355",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078390",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737604",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436359204",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071830",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071821",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027870",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097006",
      "ndc_label_name": "DiazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078360",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004703",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440737610",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004750",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097060",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071860",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027880",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097015",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004710",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004705",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071804",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919040930",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090191305",
      "ndc_label_name": "DiazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097010",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078330",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078375",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004720",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004721",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097030",
      "ndc_label_name": "DiazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919040972",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004702",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097021",
      "ndc_label_name": "DiazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090224904",
      "ndc_label_name": "DiazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001890",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004730",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004745",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027830",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187017330",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004712",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027860",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079028520",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004706",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004740",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760093430",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027845",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152306",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004725",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027875",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862094205",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004790",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919040960",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036760",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027890",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152308",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651065399",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078353",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862094210",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008830",
      "ndc_label_name": "DiazePAM TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187017301",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187017315",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078345",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006903",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008802",
      "ndc_label_name": "DiazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001821",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004701",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008860",
      "ndc_label_name": "DiazePAM TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006902",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187086710",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078370",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006904",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919040903",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001860",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004760",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036730",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745201",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152302",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090191301",
      "ndc_label_name": "DiazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006906",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187086715",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090191302",
      "ndc_label_name": "DiazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008872",
      "ndc_label_name": "DiazePAM TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036790",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745202",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152304",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090191304",
      "ndc_label_name": "DiazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267077610",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006991",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090283400",
      "ndc_label_name": "DiazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187017310",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919040902",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745208",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152307",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090299500",
      "ndc_label_name": "DiazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745206",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335219708",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436359201",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152303",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919040990",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335223903",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152309",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436359202",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828109",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335223908",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079028501",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152305",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152301",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335223905",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745209",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862094201",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335223901",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045920",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004715",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828101",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006912",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335223906",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828108",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118392609",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335223902",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027015",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118392606",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846602",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006940",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049603",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335223904",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651065301",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027020",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335223900",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651065305",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919040910",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828106",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335223907",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027060",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187086730",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027053",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027030",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008803",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006960",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846603",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027055",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045945",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267077602",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045980",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045953",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135078790",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828103",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518171300",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045960",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045955",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027070",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049601",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045915",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267006920",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040130",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335223909",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267077603",
      "ndc_label_name": "Diazepam TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027075",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745203",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027080",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828102",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045930",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518127000",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027045",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027090",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045970",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045975",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040102",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420053301",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049602",
      "ndc_label_name": "diazePAM Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81266092001",
      "ndc_label_name": "Dibucaine (Perianal) Ointment 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71399282901",
      "ndc_label_name": "Dibucaine (Perianal) Ointment 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71399282902",
      "ndc_label_name": "Dibucaine (Perianal) Ointment 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802005003",
      "ndc_label_name": "Dibucaine (Perianal) Ointment 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896013101",
      "ndc_label_name": "Dibucaine Ointment 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00168004631",
      "ndc_label_name": "Dibucaine OINTMENT 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536121195",
      "ndc_label_name": "Dibucaine Ointment 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43063084830",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084821",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093094805",
      "ndc_label_name": "Diclofenac Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065940",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135080601",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356071330",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093094801",
      "ndc_label_name": "Diclofenac Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064604",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090153500",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007230",
      "ndc_label_name": "Diclofenac Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378247401",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869706",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064600",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356071360",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064700",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589301",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090153503",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629410801",
      "ndc_label_name": "Diclofenac Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291004201",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512075010",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064603",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090064601",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090153501",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589304",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090676801",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629410802",
      "ndc_label_name": "Diclofenac Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065990",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045602",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065920",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407044301",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589300",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090676804",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007260",
      "ndc_label_name": "Diclofenac Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841106",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841103",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045703",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065930",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407091201",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589303",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742027901",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629410803",
      "ndc_label_name": "Diclofenac Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841109",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292055201",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509275006",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065960",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72819015110",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090676800",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700098960",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267007060",
      "ndc_label_name": "Diclofenac Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518218501",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710183201",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509275009",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267007030",
      "ndc_label_name": "Diclofenac Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888007301",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065928",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267007090",
      "ndc_label_name": "Diclofenac Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869709",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518218502",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335036902",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869703",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518307200",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509190001",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629410804",
      "ndc_label_name": "Diclofenac Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512090030",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292055001",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005130",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888007305",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518218500",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509275003",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045601",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045701",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804001030",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509190003",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045603",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509190009",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045702",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509190006",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509275001",
      "ndc_label_name": "Diclofenac Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090118501",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090417201",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099460",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638803",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440739730",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760026430",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799095301",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527217037",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760005830",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436692501",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420059820",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638808",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436692502",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335064801",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436067601",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083830",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060830",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060860",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420059890",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638809",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071200603",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966501",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436067602",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934002714",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420059810",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682010301",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742027801",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518190300",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071200606",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420059860",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083860",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335064802",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638801",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335123809",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099430",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335123804",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335123805",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425021001",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001061200",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966502",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335123806",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966504",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638806",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420059814",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162108608",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041403",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518190301",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041401",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420059830",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420059807",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335123801",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335123802",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041402",
      "ndc_label_name": "Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922004409",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802095301",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917021589",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536129431",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917021641",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536129434",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090278700",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00363706510",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49884093547",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268023711",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714097601",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536129497",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "21922000909",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598097710",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70512010610",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00378875006",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090725000",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55700086300",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291025611",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802016000",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090403000",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090402000",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335037101",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090724300",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50436083301",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162083366",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090280100",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54569671300",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090462100",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58602060407",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50383027201",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268023720",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700067500",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001062145",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69097052444",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187075300",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090699800",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629706901",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238205301",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518267300",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57896014001",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518133300",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81877072310",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69097072044",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55700052800",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788850001",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187076200",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518281300",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896014701",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "82429031410",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629864401",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205055200",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788777201",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205074700",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205061800",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067000",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "76282066339",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008003700",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009101",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "76282010339",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189047901",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80425023301",
      "ndc_label_name": "Diclofenac Sodium Gel 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "17478089210",
      "ndc_label_name": "Diclofenac Sodium Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090356800",
      "ndc_label_name": "Diclofenac Sodium Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208045705",
      "ndc_label_name": "Diclofenac Sodium SOLUTION 0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888015021",
      "ndc_label_name": "Diclofenac Sodium Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478089225",
      "ndc_label_name": "Diclofenac Sodium Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314001405",
      "ndc_label_name": "Diclofenac Sodium SOLUTION 0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090245400",
      "ndc_label_name": "Diclofenac Sodium Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356055425",
      "ndc_label_name": "Diclofenac Sodium Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002132502",
      "ndc_label_name": "Diclofenac Sodium SOLUTION 0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314001425",
      "ndc_label_name": "Diclofenac Sodium SOLUTION 0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888015022",
      "ndc_label_name": "Diclofenac Sodium Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420057101",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571020310",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999049242",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037730",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057130",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001027900",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603060001",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442010101",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407053601",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057190",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959037760",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057160",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888010901",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440739530",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228255011",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228255006",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440639500",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063046720",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440639585",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571020210",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571020206",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571020211",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228255096",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407053710",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440639501",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054000",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634092971",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356072560",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054200",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063046715",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440639581",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002053740",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440639560",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002053710",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353068380",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999023342",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407096718",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063046730",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291023018",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002053760",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291023010",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002053720",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054005",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054002",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043660",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078453",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063046714",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429042101",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090053802",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651084260",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090788001",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043612",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429042118",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999023328",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090053800",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060601",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054205",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651084299",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090788102",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651084201",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187071430",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054101",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090053805",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61145010109",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054301",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544084053",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407096710",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61145010106",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267035890",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054202",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090053901",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442010210",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043601",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544084080",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002053730",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61145010118",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001028006",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090788100",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407053701",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442022610",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043690",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788895203",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429042110",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442010260",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205049430",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090788105",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407096701",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442022660",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007430",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788895208",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442022601",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187052230",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057230",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407053718",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043628",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007460",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878401",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518075600",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335048105",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187071460",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057260",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043614",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043630",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629201001",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878403",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335048102",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173300",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518270701",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788895201",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043620",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060611",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001028000",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788895206",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335048107",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011000",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518270702",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518270700",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043640",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442010201",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878406",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335048103",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173303",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011001",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099530",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335048104",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043645",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057530",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878409",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173301",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173306",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019703",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099572",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173307",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001028008",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057560",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788895209",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011060",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173308",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629207701",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099578",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056901",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878408",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205049460",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934015730",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099500",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057290",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173309",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010203",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010202",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099511",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056902",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099560",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006880",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099590",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603060101",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335048101",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057201",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173302",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019702",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571020110",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440639605",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228255106",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440639685",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356042240",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228255111",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440639681",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440639601",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069253",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440739604",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228255196",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291023110",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999008914",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440739630",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999008928",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571020106",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090783804",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356071490",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571020150",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054503",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999008920",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356071430",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054409",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571020111",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090783809",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291023118",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356071460",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054508",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054401",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090783802",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054504",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054403",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407053801",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054408",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054400",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090764600",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054402",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090783808",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054509",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054500",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407053818",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054501",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090783803",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090764603",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054404",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436692401",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090764700",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090764609",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407096810",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090692400",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436692402",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090783801",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090054502",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760015360",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090783800",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090783900",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959042310",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090764602",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407096818",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090785500",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090764601",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442010301",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090785504",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090785508",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959042315",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090764608",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959042360",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436220101",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090764604",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007520",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436220102",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090785509",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959042328",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090781800",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002053615",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407053810",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090785501",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919068660",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959042302",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090785600",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002053620",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090785502",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289015010",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959042320",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436020102",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001220",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959042314",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436020101",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651084360",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090785503",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760009020",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959042330",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289015015",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187076115",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959042321",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407096801",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429042201",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289015028",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61145010218",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959042390",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289015020",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082215",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002053630",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002053610",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429042260",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083460",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007530",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083430",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083490",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267007160",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002053660",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289015030",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442010305",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651084399",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267007130",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651084301",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429042210",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518062702",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289015060",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429042218",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919068620",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687065801",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001028100",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760009060",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61145010212",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934016530",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651084305",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760009030",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001230",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760015320",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819308",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006090",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442022705",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099160",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687065811",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760009090",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629201301",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61145010206",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099100",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187076130",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442022710",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035700",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760009015",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760015315",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001028108",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442010360",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099130",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082230",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919068630",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035707",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442010310",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006030",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788980602",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442022701",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099190",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629201201",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084033311",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045607",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442022760",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001215",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512078460",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001260",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035701",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001028103",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819301",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268404",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006060",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187022260",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518062700",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629201101",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035704",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001028106",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788980603",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173404",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007560",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819303",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045603",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267007120",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035708",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518062701",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788980606",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173407",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082260",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819306",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045606",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518271500",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045601",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099178",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788980609",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509120106",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084033301",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819309",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045609",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518271501",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011105",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045604",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099111",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099155",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788980601",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518271502",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173403",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035703",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420067001",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173406",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099172",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035706",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788980608",
      "ndc_label_name": "Diclofenac Sodium TABLET DELAYED RELEASE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934067830",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011160",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045600",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005601",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173408",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420067060",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173401",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045602",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035702",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420067090",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603060403",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509120103",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173409",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005501",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018903",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045605",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035705",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056401",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603060401",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045608",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035709",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509110303",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420067030",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603060402",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268402",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509120109",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018901",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056403",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011100",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509110309",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018902",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509110306",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011101",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056402",
      "ndc_label_name": "Diclofenac Sodium Tablet Delayed Release 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093312301",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004828",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090011601",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738040",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629425401",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063018006",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781224801",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738006",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999026728",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999026730",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289059220",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289059240",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289059228",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999026740",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004830",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004820",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651056501",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004840",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267007228",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629424201",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267007220",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004841",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289059210",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267007240",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738140",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090031001",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004920",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063047330",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004928",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738104",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781225801",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093312501",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004921",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629425601",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267007328",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012028",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004940",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959004930",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012040",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090031000",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651056601",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090031004",
      "ndc_label_name": "Dicloxacillin Sodium Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267007320",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267007340",
      "ndc_label_name": "Dicloxacillin Sodium CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832605310",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378161001",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571026010",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054074825",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143312601",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527058601",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738404",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143312610",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832605311",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904698761",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979020103",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054074831",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738420",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052001",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591079401",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738412",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268019915",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547063410",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090012901",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378161005",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063011206",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722005210",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722005201",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052010",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629334103",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547063411",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090734000",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738406",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999029120",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999029130",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063011204",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979020101",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837302",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090012608",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268019911",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527058610",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090012600",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090218408",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090012602",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090012701",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205042815",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090012802",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407078310",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591079410",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090218501",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090734101",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772900",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090012800",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026509",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090218402",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959016830",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571026001",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090734002",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407078301",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135071890",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772908",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289092320",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959016800",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651071999",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090218400",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289092330",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032940",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629334102",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407036501",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629334101",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032920",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687036911",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090734008",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794806",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289092328",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267029130",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407036510",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837303",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007730",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007760",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772902",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837306",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73473080001",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794801",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032930",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934064930",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852503",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837301",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032910",
      "ndc_label_name": "Dicyclomine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789052230",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852506",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335231604",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700076630",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789052295",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857803",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852502",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651071901",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789052201",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518030202",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518030201",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794802",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789052293",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518208100",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518208101",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687036901",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004330",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789052228",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335231601",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794803",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789052290",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629334104",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852501",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789052298",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789054628",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73473080010",
      "ndc_label_name": "Dicyclomine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856116101",
      "ndc_label_name": "Dicyclomine HCl SOLUTION 10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856226101",
      "ndc_label_name": "Dicyclomine HCl Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603116158",
      "ndc_label_name": "Dicyclomine HCl SOLUTION 10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53703080016",
      "ndc_label_name": "Dicyclomine HCl SOLUTION 10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856062301",
      "ndc_label_name": "Dicyclomine HCl Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054062263",
      "ndc_label_name": "Dicyclomine HCl Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518322000",
      "ndc_label_name": "Dicyclomine HCl Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629217901",
      "ndc_label_name": "Dicyclomine HCl Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954026110",
      "ndc_label_name": "Dicyclomine HCl Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143122701",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090013000",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591079501",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738528",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738510",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527128201",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738504",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143122710",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738508",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090218600",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571025910",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722007901",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004530",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571025901",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052101",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738512",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738515",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090545408",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090730900",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722007910",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090013002",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004506",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979020001",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738520",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440738530",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760063130",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773200",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004504",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157700",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004520",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090013008",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527128210",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591079510",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032430",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090788208",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090425300",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022120",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157708",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773202",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832605211",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832605210",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078420",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407082112",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090545400",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760063830",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090218602",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090788202",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979020003",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904698861",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854009",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078460",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773208",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078415",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090430",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651072001",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004560",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090730902",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875102",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854003",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022130",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078430",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518010001",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760066530",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999008130",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090730908",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875109",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854006",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760093130",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781103",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934018230",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781106",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090157702",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090788200",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518159600",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335042503",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187041060",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854002",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934068230",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781109",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090218608",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002034520",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518176701",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335042506",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781102",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858103",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934075430",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875103",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090286300",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002034530",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011900",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046630",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335042504",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452031132",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335042505",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875106",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090307908",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002034540",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046695",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452031120",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162107703",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518010000",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090545402",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518176700",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046682",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700093390",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022100",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335042502",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002034510",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038001",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651072099",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020909",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038011",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760080230",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135042801",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046601",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335042507",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090420",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162107709",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011901",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73473090201",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135042812",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73473090210",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335042501",
      "ndc_label_name": "Dicyclomine HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335250601",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046690",
      "ndc_label_name": "Dicyclomine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862031130",
      "ndc_label_name": "Didanosine Capsule Delayed Release 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862031230",
      "ndc_label_name": "Didanosine Capsule Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356025930",
      "ndc_label_name": "Didanosine Capsule Delayed Release 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292060560",
      "ndc_label_name": "Digoxin Solution 0.05 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054005746",
      "ndc_label_name": "Digoxin Solution 0.05 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689032702",
      "ndc_label_name": "Digoxin Solution 0.05 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856005701",
      "ndc_label_name": "Digoxin Solution 0.05 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856005730",
      "ndc_label_name": "Digoxin Solution 0.05 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135074701",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714059002",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664043788",
      "ndc_label_name": "Digoxin TABLET 125 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135053401",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143124001",
      "ndc_label_name": "Digoxin TABLET 125 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904592161",
      "ndc_label_name": "Digoxin TABLET 125 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143124010",
      "ndc_label_name": "Digoxin TABLET 125 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083530",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353049860",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687054001",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651043799",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664043718",
      "ndc_label_name": "Digoxin TABLET 125 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440739090",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135053410",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135074710",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268023811",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629257902",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687085801",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429009901",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429009910",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714059001",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090564201",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687085811",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651043701",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267044330",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090670801",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629257903",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518312400",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083560",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687054011",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187074010",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629257904",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238199101",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629257901",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954020110",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335246301",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268023815",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238199107",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82685020110",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629257905",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335246302",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954020120",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162226802",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162226804",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187074090",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162226801",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82685020101",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162226800",
      "ndc_label_name": "Digoxin Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440739130",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651043899",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714059102",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135053510",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143124110",
      "ndc_label_name": "Digoxin TABLET 250 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135053501",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135074810",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143124101",
      "ndc_label_name": "Digoxin TABLET 250 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440739190",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429010001",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238199201",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055101",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664044188",
      "ndc_label_name": "Digoxin TABLET 250 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353051160",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714059101",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135074801",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904592261",
      "ndc_label_name": "Digoxin TABLET 250 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629387004",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090786501",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055111",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162226900",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664044118",
      "ndc_label_name": "Digoxin TABLET 250 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687086901",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090586201",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090658801",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162226904",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687086911",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629387001",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82685020210",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429010010",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629387002",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651043801",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629387003",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82685020201",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518295900",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954020220",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238199207",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518103600",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954020210",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335246401",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162226902",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335246402",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162226901",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804024490",
      "ndc_label_name": "Digoxin Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335066983",
      "ndc_label_name": "Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335066913",
      "ndc_label_name": "Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658034130",
      "ndc_label_name": "Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658034190",
      "ndc_label_name": "Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335066981",
      "ndc_label_name": "Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682036790",
      "ndc_label_name": "Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682036890",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067083",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067013",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067081",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658034230",
      "ndc_label_name": "dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335083902",
      "ndc_label_name": "dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658034290",
      "ndc_label_name": "dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067181",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518199300",
      "ndc_label_name": "dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658034390",
      "ndc_label_name": "dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353090783",
      "ndc_label_name": "dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658017230",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189024890",
      "ndc_label_name": "Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067183",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067113",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658034330",
      "ndc_label_name": "dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682036990",
      "ndc_label_name": "Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335158501",
      "ndc_label_name": "dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335158502",
      "ndc_label_name": "dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658017330",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658034430",
      "ndc_label_name": "Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658034490",
      "ndc_label_name": "Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067283",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682037090",
      "ndc_label_name": "Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067281",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353090679",
      "ndc_label_name": "Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067213",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658034590",
      "ndc_label_name": "dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353090379",
      "ndc_label_name": "Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658017430",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658034530",
      "ndc_label_name": "dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067383",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067313",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629798102",
      "ndc_label_name": "dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999049910",
      "ndc_label_name": "dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682037190",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067381",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 360 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658034690",
      "ndc_label_name": "Diltiazem HCl ER Beads CAPSULE EXTENDED RELEASE 24 HOUR 420 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682037290",
      "ndc_label_name": "Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 420 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729030301",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714052301",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714052302",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729030316",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436019102",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436019101",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440740090",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332081531",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729030416",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714052402",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729030401",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714052401",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332081631",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436019201",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436019202",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714052501",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436019301",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436019302",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714052502",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332081731",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729030501",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729030516",
      "ndc_label_name": "dilTIAZem HCl ER Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067513",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291018490",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382059505",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090259300",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904721761",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370082909",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090259301",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291018450",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742024890",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090541601",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788723709",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304071805",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370082905",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979002606",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090541600",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090632800",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687019511",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687019501",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335208901",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629215401",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370082911",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335074503",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788723703",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304071890",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629215301",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682099398",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763409",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763403",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979002602",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763401",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787001",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788723708",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788723701",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763408",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979002607",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763406",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787003",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518278900",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067581",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518101700",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787006",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787008",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090632801",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335074501",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742024830",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407047390",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382059516",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788723706",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787009",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335064302",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370083005",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904721861",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979002707",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090287000",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090287001",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742024990",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370083011",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407047490",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979002702",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370083009",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291018550",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629215501",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629215601",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090546600",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979002706",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335104301",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291018590",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090614600",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067613",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071052230",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382059616",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090546601",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067681",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304071905",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090614601",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742024930",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687020601",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687020611",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304071990",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382059605",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518250600",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682099498",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335064301",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335970801",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904721961",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090781501",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370083105",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370083111",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370083109",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090545201",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090545200",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979002806",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979002802",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021701",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090288400",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979002807",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291018690",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742025090",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090615500",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067713",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067781",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382059716",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289077414",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291018650",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090781500",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739001610",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407047590",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382059705",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742025030",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090288401",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021711",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090615501",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071033930",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629215801",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304072005",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629215701",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304072090",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682099798",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000902",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518329900",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518333700",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000901",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067881",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370083211",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979002906",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687022801",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370083209",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904722061",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382059805",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979002902",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291018790",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291018750",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742025130",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304072190",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306100",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370083205",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742025190",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407047690",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306201",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629216001",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304072105",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629215901",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382059816",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979002907",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034490",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335067813",
      "ndc_label_name": "Diltiazem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040990",
      "ndc_label_name": "dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687022811",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682099898",
      "ndc_label_name": "DilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093032101",
      "ndc_label_name": "Diltiazem HCl TABLET 120 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228048401",
      "ndc_label_name": "dilTIAZem HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135033690",
      "ndc_label_name": "dilTIAZem HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187076930",
      "ndc_label_name": "dilTIAZem HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682000910",
      "ndc_label_name": "Diltiazem HCl TABLET 120 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440741390",
      "ndc_label_name": "dilTIAZem HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518268301",
      "ndc_label_name": "dilTIAZem HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629909901",
      "ndc_label_name": "dilTIAZem HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518268302",
      "ndc_label_name": "dilTIAZem HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799013201",
      "ndc_label_name": "dilTIAZem HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162188301",
      "ndc_label_name": "dilTIAZem HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332078431",
      "ndc_label_name": "dilTIAZem HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518268300",
      "ndc_label_name": "dilTIAZem HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093031805",
      "ndc_label_name": "Diltiazem HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682000610",
      "ndc_label_name": "Diltiazem HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228048101",
      "ndc_label_name": "dilTIAZem HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093031801",
      "ndc_label_name": "Diltiazem HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799012901",
      "ndc_label_name": "dilTIAZem HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687071701",
      "ndc_label_name": "dilTIAZem HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332078131",
      "ndc_label_name": "dilTIAZem HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440741090",
      "ndc_label_name": "dilTIAZem HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799012902",
      "ndc_label_name": "dilTIAZem HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682000650",
      "ndc_label_name": "Diltiazem HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228048105",
      "ndc_label_name": "dilTIAZem HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440741094",
      "ndc_label_name": "dilTIAZem HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518004000",
      "ndc_label_name": "dilTIAZem HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135033312",
      "ndc_label_name": "dilTIAZem HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687071711",
      "ndc_label_name": "dilTIAZem HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518010900",
      "ndc_label_name": "dilTIAZem HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090045103",
      "ndc_label_name": "Diltiazem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440741194",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090045102",
      "ndc_label_name": "Diltiazem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682000750",
      "ndc_label_name": "Diltiazem HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093031905",
      "ndc_label_name": "Diltiazem HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440741190",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093031901",
      "ndc_label_name": "Diltiazem HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799013001",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072801",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440741191",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740102",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799013002",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356002600",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090249502",
      "ndc_label_name": "Diltiazem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072811",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332078231",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228048201",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740103",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629364901",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518082000",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135033412",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228048205",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682000710",
      "ndc_label_name": "Diltiazem HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629910201",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162188101",
      "ndc_label_name": "dilTIAZem HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356002700",
      "ndc_label_name": "dilTIAZem HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162188201",
      "ndc_label_name": "dilTIAZem HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332078331",
      "ndc_label_name": "dilTIAZem HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518109600",
      "ndc_label_name": "dilTIAZem HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440741290",
      "ndc_label_name": "dilTIAZem HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228048305",
      "ndc_label_name": "dilTIAZem HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799013101",
      "ndc_label_name": "dilTIAZem HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093032001",
      "ndc_label_name": "Diltiazem HCl TABLET 90 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799013102",
      "ndc_label_name": "dilTIAZem HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289089330",
      "ndc_label_name": "Diltiazem HCl TABLET 90 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682000810",
      "ndc_label_name": "Diltiazem HCl TABLET 90 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228048301",
      "ndc_label_name": "dilTIAZem HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440741294",
      "ndc_label_name": "dilTIAZem HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335057902",
      "ndc_label_name": "dilTIAZem HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135033590",
      "ndc_label_name": "dilTIAZem HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629910401",
      "ndc_label_name": "dilTIAZem HCl Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682000850",
      "ndc_label_name": "Diltiazem HCl TABLET 90 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00031214623",
      "ndc_label_name": "Dimetapp Night Cold/Congestion Liquid 6.25-2.5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00378039614",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651008314",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722065731",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342034994",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729041604",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598042952",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547002414",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979012721",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82249074514",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512085214",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877055514",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407044214",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180077614",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097032289",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238131804",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979012804",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090672200",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378039991",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877055660",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378039918",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180077707",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729041712",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729041759",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598043060",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238131906",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342035009",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407044160",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722065832",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009013860",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547002506",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651008460",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090528800",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512085360",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097032303",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82249074760",
      "ndc_label_name": "Dimethyl Fumarate Capsule Delayed Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43292055765",
      "ndc_label_name": "DiphenhydrAMINE HCl (Sleep) TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056765",
      "ndc_label_name": "DiphenhydrAMINE HCl (Sleep) TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135015601",
      "ndc_label_name": "DiphenhydrAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440742630",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440742606",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10267083604",
      "ndc_label_name": "DiphenhydrAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10267083601",
      "ndc_label_name": "DiphenhydrAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440742609",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135015610",
      "ndc_label_name": "DiphenhydrAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440742604",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135015613",
      "ndc_label_name": "DiphenhydrAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904205661",
      "ndc_label_name": "diphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43063072030",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "42806064901",
      "ndc_label_name": "DiphenhydrAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43063072010",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440742620",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "42806064910",
      "ndc_label_name": "DiphenhydrAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440742612",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43063072040",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090216203",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090216205",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090216202",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54348065006",
      "ndc_label_name": "diphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43063072020",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959005330",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440742660",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959005310",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50436376201",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959005315",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54348065002",
      "ndc_label_name": "diphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54348065020",
      "ndc_label_name": "diphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959005352",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54348065050",
      "ndc_label_name": "diphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43063072015",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399802601",
      "ndc_label_name": "diphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959005312",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54738011601",
      "ndc_label_name": "DiphenhydrAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959005306",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61919007930",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289010040",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289010015",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54738011603",
      "ndc_label_name": "DiphenhydrAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "82568000501",
      "ndc_label_name": "diphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959005320",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335008102",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187086610",
      "ndc_label_name": "DiphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267008130",
      "ndc_label_name": "DiphenhydrAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267008120",
      "ndc_label_name": "DiphenhydrAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267008115",
      "ndc_label_name": "DiphenhydrAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399102802",
      "ndc_label_name": "diphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267008160",
      "ndc_label_name": "DiphenhydrAMINE HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54348065001",
      "ndc_label_name": "diphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399102801",
      "ndc_label_name": "diphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789053230",
      "ndc_label_name": "diphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "82568000502",
      "ndc_label_name": "diphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187086630",
      "ndc_label_name": "DiphenhydrAMINE HCl CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71399802602",
      "ndc_label_name": "diphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789053220",
      "ndc_label_name": "diphenhydrAMINE HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094002459",
      "ndc_label_name": "diphenhydrAMINE HCl Childrens Liquid 12.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57237030516",
      "ndc_label_name": "diphenhydrAMINE HCl Childrens Liquid 12.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094002259",
      "ndc_label_name": "DiphenhydrAMINE HCl Childrens Liquid 12.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57237030512",
      "ndc_label_name": "diphenhydrAMINE HCl Childrens Liquid 12.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094002462",
      "ndc_label_name": "diphenhydrAMINE HCl Childrens Liquid 12.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094002262",
      "ndc_label_name": "DiphenhydrAMINE HCl Childrens Liquid 12.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121097810",
      "ndc_label_name": "diphenhydrAMINE HCl Elixir 12.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121048905",
      "ndc_label_name": "diphenhydrAMINE HCl Elixir 12.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121048910",
      "ndc_label_name": "diphenhydrAMINE HCl Elixir 12.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121048900",
      "ndc_label_name": "diphenhydrAMINE HCl Elixir 12.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012306",
      "ndc_label_name": "DiphenhydrAMINE HCl Elixir 12.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121097800",
      "ndc_label_name": "diphenhydrAMINE HCl Elixir 12.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012303",
      "ndc_label_name": "DiphenhydrAMINE HCl Elixir 12.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00641037621",
      "ndc_label_name": "DiphenhydrAMINE HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323066416",
      "ndc_label_name": "DiphenhydrAMINE HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641628225",
      "ndc_label_name": "diphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154936305",
      "ndc_label_name": "DiphenhydrAMINE HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641037625",
      "ndc_label_name": "DiphenhydrAMINE HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155026431",
      "ndc_label_name": "diphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045010200",
      "ndc_label_name": "diphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323066401",
      "ndc_label_name": "DiphenhydrAMINE HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641628201",
      "ndc_label_name": "diphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634078101",
      "ndc_label_name": "diphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155026331",
      "ndc_label_name": "diphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485010101",
      "ndc_label_name": "DiphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090087800",
      "ndc_label_name": "DiphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323066400",
      "ndc_label_name": "DiphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045010210",
      "ndc_label_name": "DiphenhydrAMINE HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518108200",
      "ndc_label_name": "diphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155026441",
      "ndc_label_name": "diphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457012410",
      "ndc_label_name": "diphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090184100",
      "ndc_label_name": "DiphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485010105",
      "ndc_label_name": "diphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518333201",
      "ndc_label_name": "diphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634078141",
      "ndc_label_name": "diphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021048101",
      "ndc_label_name": "diphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323066441",
      "ndc_label_name": "DiphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518108201",
      "ndc_label_name": "diphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518333200",
      "ndc_label_name": "diphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485010125",
      "ndc_label_name": "DiphenhydrAMINE HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "20254020801",
      "ndc_label_name": "DiphenhydrAMINE HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50488412501",
      "ndc_label_name": "diphenhydrAMINE HCl Tablet Chewable 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "XXXMS127557",
      "ndc_label_name": "Diphenhydramine-Phenylephrine Tablet 25-10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054319446",
      "ndc_label_name": "Diphenoxylate-Atropine Liquid 2.5-0.025 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959094960",
      "ndc_label_name": "Diphenoxylate-Atropine Liquid 2.5-0.025 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70166063001",
      "ndc_label_name": "Diphenoxylate-Atropine Liquid 2.5-0.025 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353048953",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440743510",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378041501",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378041510",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353048930",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406123610",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832059010",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378041577",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353048970",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063095720",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527117001",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063008906",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090345601",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059460",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063008904",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406123601",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059490",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008370",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527117010",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063095715",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090558900",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090003902",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063095710",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832059011",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090004000",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008380",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090003901",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353048960",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008020",
      "ndc_label_name": "Diphenoxylate-Atropine TABLET 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090380402",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008353",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063095704",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959015700",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059453",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090287201",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059480",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135061812",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293061810",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008360",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008330",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959015710",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090287200",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090380400",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090003900",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090930",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959015730",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008390",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059430",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959015720",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959015715",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293061801",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090287202",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090960",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959015750",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059470",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999020730",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090955",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289010215",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762106102",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090345200",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335031102",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002034010",
      "ndc_label_name": "Diphenoxylate-Atropine TABLET 2.5-0.025 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264100",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090345600",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080953",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289010230",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559049010",
      "ndc_label_name": "Diphenoxylate-Atropine TABLET 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959015712",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385010701",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002034020",
      "ndc_label_name": "Diphenoxylate-Atropine TABLET 2.5-0.025 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090345602",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090381300",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080990",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762106101",
      "ndc_label_name": "Diphenoxylate-Atropine TABLET 2.5-0.025 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629193301",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002034015",
      "ndc_label_name": "Diphenoxylate-Atropine TABLET 2.5-0.025 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826010790",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002034030",
      "ndc_label_name": "Diphenoxylate-Atropine TABLET 2.5-0.025 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090380401",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090558902",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315091010",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919040530",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090558901",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348001810",
      "ndc_label_name": "Diphenoxylate-Atropine TABLET 2.5-0.025 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090911",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687089001",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008010",
      "ndc_label_name": "Diphenoxylate-Atropine TABLET 2.5-0.025 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629193401",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056680",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187093910",
      "ndc_label_name": "Diphenoxylate-Atropine TABLET 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629917601",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289010210",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071470",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919040520",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090900",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090990",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071490",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071460",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056630",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289010220",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789037525",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518213500",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056653",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071430",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826010703",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162176500",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687089011",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056660",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071453",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162176501",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559049001",
      "ndc_label_name": "Diphenoxylate-Atropine TABLET 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056690",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071480",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385010710",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629917501",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826010700",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080960",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315091001",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080970",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335031104",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080980",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056670",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189033610",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189033630",
      "ndc_label_name": "Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089400",
      "ndc_label_name": "Dipyridamole Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089411",
      "ndc_label_name": "Dipyridamole Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559023501",
      "ndc_label_name": "Dipyridamole Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584018110",
      "ndc_label_name": "Dipyridamole Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135053610",
      "ndc_label_name": "Dipyridamole Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407062601",
      "ndc_label_name": "Dipyridamole Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089460",
      "ndc_label_name": "Dipyridamole Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115107001",
      "ndc_label_name": "Dipyridamole Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089490",
      "ndc_label_name": "Dipyridamole Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089430",
      "ndc_label_name": "Dipyridamole Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980013301",
      "ndc_label_name": "Dipyridamole Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089455",
      "ndc_label_name": "Dipyridamole Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980013310",
      "ndc_label_name": "Dipyridamole Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382018701",
      "ndc_label_name": "Dipyridamole Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407062701",
      "ndc_label_name": "Dipyridamole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980013410",
      "ndc_label_name": "Dipyridamole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089511",
      "ndc_label_name": "Dipyridamole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135053710",
      "ndc_label_name": "Dipyridamole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559023601",
      "ndc_label_name": "Dipyridamole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089590",
      "ndc_label_name": "Dipyridamole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382018801",
      "ndc_label_name": "Dipyridamole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115107101",
      "ndc_label_name": "Dipyridamole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584018210",
      "ndc_label_name": "Dipyridamole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089560",
      "ndc_label_name": "Dipyridamole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980013401",
      "ndc_label_name": "Dipyridamole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089555",
      "ndc_label_name": "Dipyridamole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089500",
      "ndc_label_name": "Dipyridamole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089530",
      "ndc_label_name": "Dipyridamole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559023701",
      "ndc_label_name": "Dipyridamole Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135053810",
      "ndc_label_name": "Dipyridamole Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089690",
      "ndc_label_name": "Dipyridamole Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089611",
      "ndc_label_name": "Dipyridamole Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980013501",
      "ndc_label_name": "Dipyridamole Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089655",
      "ndc_label_name": "Dipyridamole Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980013510",
      "ndc_label_name": "Dipyridamole Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115107201",
      "ndc_label_name": "Dipyridamole Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584018310",
      "ndc_label_name": "Dipyridamole Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407062801",
      "ndc_label_name": "Dipyridamole Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382018901",
      "ndc_label_name": "Dipyridamole Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089660",
      "ndc_label_name": "Dipyridamole Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089600",
      "ndc_label_name": "Dipyridamole Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089630",
      "ndc_label_name": "Dipyridamole Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907002701",
      "ndc_label_name": "Disopyramide Phosphate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762038601",
      "ndc_label_name": "Disopyramide Phosphate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093312701",
      "ndc_label_name": "Disopyramide Phosphate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862009501",
      "ndc_label_name": "Disopyramide Phosphate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291023401",
      "ndc_label_name": "Disopyramide Phosphate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862009601",
      "ndc_label_name": "Disopyramide Phosphate Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093312901",
      "ndc_label_name": "Disopyramide Phosphate CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762040001",
      "ndc_label_name": "Disopyramide Phosphate Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291023501",
      "ndc_label_name": "Disopyramide Phosphate Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907002601",
      "ndc_label_name": "Disopyramide Phosphate Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135043190",
      "ndc_label_name": "Disulfiram Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054035613",
      "ndc_label_name": "Disulfiram Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054035625",
      "ndc_label_name": "Disulfiram Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980017103",
      "ndc_label_name": "Disulfiram Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794002808",
      "ndc_label_name": "Disulfiram Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429019601",
      "ndc_label_name": "Disulfiram TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781060730",
      "ndc_label_name": "Disulfiram TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135043130",
      "ndc_label_name": "Disulfiram Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429019630",
      "ndc_label_name": "Disulfiram TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054035725",
      "ndc_label_name": "Disulfiram Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135043290",
      "ndc_label_name": "Disulfiram Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980017203",
      "ndc_label_name": "Disulfiram Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794002908",
      "ndc_label_name": "Disulfiram Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135043230",
      "ndc_label_name": "Disulfiram Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904636345",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180026002",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378047201",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300038005",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268025911",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378047205",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722002101",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378047277",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722002105",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518113801",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714048402",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079076601",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001064600",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904636361",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111053301",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714048401",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028980",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518178101",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268025915",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687090401",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001064603",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300038001",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001010500",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111053305",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180026001",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028960",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015760",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687090411",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518155601",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079076608",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001010503",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862059499",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518155602",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075550",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518031200",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075510",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518178102",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084031001",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518113800",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084031011",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518318300",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003030",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003060",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862059401",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028975",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028992",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162251501",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518113802",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789028660",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518155600",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003075",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003080",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003092",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015775",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028930",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904636461",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031060",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378047305",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904718245",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054753",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378047377",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904718261",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378047301",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722002201",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268026011",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904636445",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300038105",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090473701",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714048501",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300038101",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031080",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054730",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079076708",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031053",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090578301",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090578300",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714048502",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090607401",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054775",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054770",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862059501",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054780",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090607400",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862059505",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722002205",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687091501",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079076701",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353092853",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518203600",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090473700",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268026013",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001064700",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031070",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788717703",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111053401",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353092870",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024953",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111053405",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687091502",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180026102",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054760",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020560",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629469802",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090268600",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031153",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075710",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687091511",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788717709",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353092860",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070753",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162075750",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784100",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784101",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001010603",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518203601",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835806",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084041502",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070770",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001064703",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687091593",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020160",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180026101",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020153",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835809",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070760",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808503",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084041511",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629469801",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020570",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835803",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788717706",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335188302",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024970",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335188303",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808506",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001010600",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808509",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031160",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020580",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020530",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024930",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162237101",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024960",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084041501",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031170",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020553",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162237105",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084041593",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189045960",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020575",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335188301",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024980",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020170",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162251601",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070780",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162251605",
      "ndc_label_name": "Divalproex Sodium ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111052901",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021111",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300013805",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300013801",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832712215",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832712211",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237010601",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001055400",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237010605",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021121",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001047203",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090486100",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090712100",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090763500",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452043320",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001055403",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756079613",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687085721",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518266500",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452043330",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756079688",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687085711",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001047200",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518037400",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382003101",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832712315",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090303800",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832712311",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111053001",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090200700",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760069860",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832712301",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832712389",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904686061",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187074230",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700093860",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237004701",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919080960",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001047300",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300013901",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090112300",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300013905",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382003205",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187074260",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756079788",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382003201",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001047303",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356061460",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090284900",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090776300",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718303",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407906",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040201",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788814503",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001055500",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090112301",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090341600",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090776301",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718306",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860903",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407909",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860906",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084077601",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090200701",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237004705",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687086801",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718309",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452043430",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162231601",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335286201",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407903",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756079713",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687086811",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040205",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335288501",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518251301",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162246005",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001055503",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452043420",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305502",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071077530",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084077611",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305500",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518305501",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189063660",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162246001",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000801",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162246003",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860909",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000802",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000803",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000804",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035301",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162231605",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003160",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518251300",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804023330",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629427802",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090440900",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832712489",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832712411",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832712401",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090279500",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904686190",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584200",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040301",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919024930",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300014001",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832712415",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700093960",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584300",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300014005",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237004801",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001047400",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756079888",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090266700",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904686161",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001055600",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629427801",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111053101",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756079813",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084078261",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452043530",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687087911",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237004805",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518336401",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382003301",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629427803",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187074360",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335215802",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335278201",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687087961",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760079860",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335215805",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003260",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035401",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040305",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919024960",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064830",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064860",
      "ndc_label_name": "Divalproex Sodium TABLET DELAYED RELEASE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335215801",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001047403",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187074390",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452043520",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335215804",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335215803",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001055603",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003253",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382003305",
      "ndc_label_name": "Divalproex Sodium Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090725800",
      "ndc_label_name": "DM-guaiFENesin ER Tablet Extended Release 12 Hour 60-1200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51660007354",
      "ndc_label_name": "DM-guaiFENesin ER Tablet Extended Release 12 Hour 60-1200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51660007386",
      "ndc_label_name": "DM-guaiFENesin ER Tablet Extended Release 12 Hour 60-1200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904699760",
      "ndc_label_name": "Docusate Calcium Capsule 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135013810",
      "ndc_label_name": "Docusate Calcium CAPSULE 240 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135013805",
      "ndc_label_name": "Docusate Calcium CAPSULE 240 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135013803",
      "ndc_label_name": "Docusate Calcium CAPSULE 240 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135013830",
      "ndc_label_name": "Docusate Calcium CAPSULE 240 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440746860",
      "ndc_label_name": "Docusate Calcium Capsule 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135013860",
      "ndc_label_name": "Docusate Calcium CAPSULE 240 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904699740",
      "ndc_label_name": "Docusate Calcium Capsule 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904699780",
      "ndc_label_name": "Docusate Calcium Capsule 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "17856375520",
      "ndc_label_name": "Docusate Calcium Capsule 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135013861",
      "ndc_label_name": "Docusate Calcium CAPSULE 240 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135013813",
      "ndc_label_name": "Docusate Calcium CAPSULE 240 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268026611",
      "ndc_label_name": "Docusate Calcium Capsule 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268026615",
      "ndc_label_name": "Docusate Calcium Capsule 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54629064001",
      "ndc_label_name": "Docusate Calcium Capsule 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896042401",
      "ndc_label_name": "Docusate Calcium Capsule 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904692093",
      "ndc_label_name": "Docusate Mini Enema 283 MG/5ML Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904699980",
      "ndc_label_name": "Docusate Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904699960",
      "ndc_label_name": "Docusate Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268026811",
      "ndc_label_name": "Docusate Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440746660",
      "ndc_label_name": "Docusate Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268026815",
      "ndc_label_name": "Docusate Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440746630",
      "ndc_label_name": "Docusate Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440746690",
      "ndc_label_name": "Docusate Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904728160",
      "ndc_label_name": "Docusate Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094005259",
      "ndc_label_name": "Docusate Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135013605",
      "ndc_label_name": "Docusate Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135013613",
      "ndc_label_name": "Docusate Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135013601",
      "ndc_label_name": "Docusate Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "48433010101",
      "ndc_label_name": "Docusate Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904728180",
      "ndc_label_name": "Docusate Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135013610",
      "ndc_label_name": "Docusate Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504031621",
      "ndc_label_name": "Docusate Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135013630",
      "ndc_label_name": "Docusate Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54629060199",
      "ndc_label_name": "Docusate Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999079060",
      "ndc_label_name": "Docusate Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094005261",
      "ndc_label_name": "Docusate Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135013660",
      "ndc_label_name": "Docusate Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267027530",
      "ndc_label_name": "Docusate Sodium CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54629060101",
      "ndc_label_name": "Docusate Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789016660",
      "ndc_label_name": "Docusate Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335063202",
      "ndc_label_name": "Docusate Sodium Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54859081316",
      "ndc_label_name": "Docusate Sodium Liquid 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121093516",
      "ndc_label_name": "Docusate Sodium Liquid 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896041316",
      "ndc_label_name": "Docusate Sodium Liquid 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121093540",
      "ndc_label_name": "Docusate Sodium Liquid 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "48433020510",
      "ndc_label_name": "Docusate Sodium Liquid 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121093505",
      "ndc_label_name": "Docusate Sodium Liquid 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536130485",
      "ndc_label_name": "Docusate Sodium Liquid 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896042316",
      "ndc_label_name": "Docusate Sodium Liquid 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "48433020725",
      "ndc_label_name": "Docusate Sodium Syrup 60 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864075099",
      "ndc_label_name": "Docusate Sodium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864075010",
      "ndc_label_name": "Docusate Sodium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864000021",
      "ndc_label_name": "Docusate Sodium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16571077910",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904647861",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077909",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010310",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010326",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010390",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077903",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010330",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722073805",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722073830",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009330",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582031209",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014010",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722073890",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077950",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547027603",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342002807",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342002815",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335041602",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033030",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065990",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547027611",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342002810",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090128700",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032210",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582031230",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009012005",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032230",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111035705",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033090",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547027609",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262700",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862032690",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111035730",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009390",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032290",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111035710",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380090804",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009391",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213703",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335041601",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687030301",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380090807",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687030311",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111035790",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012805",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012801",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862032699",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335058201",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862032630",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012806",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012803",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380090805",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213705",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335058202",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213709",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213700",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026590",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071152303",
      "ndc_label_name": "Donepezil HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335041603",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335058203",
      "ndc_label_name": "Donepezil HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010290",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077850",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010240",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904647761",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077803",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010210",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010230",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722013910",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722073705",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582031109",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722073730",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582031130",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077809",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722073790",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077810",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304012877",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342002710",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090291000",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547027509",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032110",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736500",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090353700",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342002707",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862032530",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090632900",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009291",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111035610",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032130",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111035690",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746032930",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342002715",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862032590",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111035605",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820803",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746032990",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687029211",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820809",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429032190",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547027503",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862032599",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111035630",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820806",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071158003",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009290",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871109",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012701",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547027511",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003160",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919075090",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213603",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773203",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380090707",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003130",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012703",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687029201",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012705",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009230",
      "ndc_label_name": "Donepezil HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213609",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213600",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213605",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380090704",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009011905",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380090705",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871103",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773206",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871106",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773209",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003190",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012706",
      "ndc_label_name": "Donepezil HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300025187",
      "ndc_label_name": "Donepezil HCl Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300025111",
      "ndc_label_name": "Donepezil HCl Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781527764",
      "ndc_label_name": "Donepezil HCl Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342003007",
      "ndc_label_name": "Donepezil HCl TABLET DISPERSIBLE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382034706",
      "ndc_label_name": "Donepezil HCl Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781527664",
      "ndc_label_name": "Donepezil HCl Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300025011",
      "ndc_label_name": "Donepezil HCl Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382034606",
      "ndc_label_name": "Donepezil HCl Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300025087",
      "ndc_label_name": "Donepezil HCl Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342002907",
      "ndc_label_name": "Donepezil HCl TABLET DISPERSIBLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "25021000610",
      "ndc_label_name": "Dorzolamide HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090488200",
      "ndc_label_name": "Dorzolamide HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429011410",
      "ndc_label_name": "Dorzolamide HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571014126",
      "ndc_label_name": "Dorzolamide HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383023210",
      "ndc_label_name": "Dorzolamide HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314001910",
      "ndc_label_name": "Dorzolamide HCl SOLUTION 2 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090124600",
      "ndc_label_name": "Dorzolamide HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208048510",
      "ndc_label_name": "Dorzolamide HCl SOLUTION 2 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888007715",
      "ndc_label_name": "Dorzolamide HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315030410",
      "ndc_label_name": "Dorzolamide HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71384051610",
      "ndc_label_name": "Dorzolamide HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090240600",
      "ndc_label_name": "Dorzolamide HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069050101",
      "ndc_label_name": "Dorzolamide HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332051910",
      "ndc_label_name": "Dorzolamide HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377008111",
      "ndc_label_name": "Dorzolamide HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921040010",
      "ndc_label_name": "Dorzolamide HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266019701",
      "ndc_label_name": "Dorzolamide HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71384051910",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24208048610",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162218402",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383023310",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315030510",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090124700",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162238102",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571014726",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921022610",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090681400",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069005101",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011510",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090637100",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61314003002",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377008211",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862094601",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332055310",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162216602",
      "ndc_label_name": "Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49702024661",
      "ndc_label_name": "Dovato Tablet 50-300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49702024613",
      "ndc_label_name": "Dovato Tablet 50-300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49702024633",
      "ndc_label_name": "Dovato Tablet 50-300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093207001",
      "ndc_label_name": "Doxazosin Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268022215",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729021101",
      "ndc_label_name": "Doxazosin Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747060",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904552261",
      "ndc_label_name": "Doxazosin Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832035611",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747091",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747030",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747090",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762138807",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035110",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035101",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651089201",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762231006",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090070100",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762241007",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571016501",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084083601",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090215300",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651089299",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084083625",
      "ndc_label_name": "Doxazosin Mesylate TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505009301",
      "ndc_label_name": "Doxazosin Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084083611",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135005190",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729021117",
      "ndc_label_name": "Doxazosin Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382078301",
      "ndc_label_name": "Doxazosin Mesylate TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155009201",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084083695",
      "ndc_label_name": "Doxazosin Mesylate TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268022211",
      "ndc_label_name": "Doxazosin Mesylate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382078310",
      "ndc_label_name": "Doxazosin Mesylate TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505009300",
      "ndc_label_name": "Doxazosin Mesylate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747190",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093206901",
      "ndc_label_name": "Doxazosin Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353064760",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747191",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747130",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155009301",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747160",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571016601",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832035711",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291025810",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505009401",
      "ndc_label_name": "Doxazosin Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651089301",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729041417",
      "ndc_label_name": "Doxazosin Mesylate TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090640100",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729041401",
      "ndc_label_name": "Doxazosin Mesylate TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035201",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904552361",
      "ndc_label_name": "Doxazosin Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090070400",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788732803",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085125",
      "ndc_label_name": "Doxazosin Mesylate TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268022311",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762232006",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651089399",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035210",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073960",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090577300",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842203",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842201",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505009400",
      "ndc_label_name": "Doxazosin Mesylate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085101",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842206",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073990",
      "ndc_label_name": "Doxazosin Mesylate TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135005290",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762242007",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335030903",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268022315",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085111",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085195",
      "ndc_label_name": "Doxazosin Mesylate TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015360",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382078410",
      "ndc_label_name": "Doxazosin Mesylate TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842209",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025160",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382078401",
      "ndc_label_name": "Doxazosin Mesylate TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788732806",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011760",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048260",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335030901",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788732809",
      "ndc_label_name": "Doxazosin Mesylate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904552461",
      "ndc_label_name": "Doxazosin Mesylate TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093206801",
      "ndc_label_name": "Doxazosin Mesylate TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035310",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747260",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747290",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747230",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074060",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729021317",
      "ndc_label_name": "Doxazosin Mesylate TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155009401",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353064560",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353064860",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832135811",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291025910",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747291",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090070600",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090070602",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090070601",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217200",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090629802",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571016701",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061260",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729021301",
      "ndc_label_name": "Doxazosin Mesylate TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268022411",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090629800",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651089401",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217202",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651089499",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035301",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090392701",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291025901",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084086201",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090629801",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788714906",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762234006",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084086211",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217201",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090392702",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090780300",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788714903",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090780301",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841209",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084086225",
      "ndc_label_name": "Doxazosin Mesylate TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841201",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090392700",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090780302",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268022415",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841206",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762244007",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762139007",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382078501",
      "ndc_label_name": "Doxazosin Mesylate TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092760",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135005390",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505009500",
      "ndc_label_name": "Doxazosin Mesylate TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084086295",
      "ndc_label_name": "Doxazosin Mesylate TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788714909",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382078510",
      "ndc_label_name": "Doxazosin Mesylate TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505009501",
      "ndc_label_name": "Doxazosin Mesylate TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042060",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004309",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841203",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004360",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610078960",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092753",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012060",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012009",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042009",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096553",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092780",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096560",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096570",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804008730",
      "ndc_label_name": "Doxazosin Mesylate Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093206701",
      "ndc_label_name": "Doxazosin Mesylate TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061360",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747391",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747360",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747390",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571016801",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090073401",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832135911",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440747330",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090215400",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729041501",
      "ndc_label_name": "Doxazosin Mesylate TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035401",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268022515",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729041517",
      "ndc_label_name": "Doxazosin Mesylate TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011060",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155009501",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291026001",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268022511",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035410",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291026010",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651089501",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544027360",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353064660",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762238006",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090314300",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083153",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090314301",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090073400",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382078601",
      "ndc_label_name": "Doxazosin Mesylate TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087880",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118812303",
      "ndc_label_name": "Doxazosin Mesylate TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544027345",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505009601",
      "ndc_label_name": "Doxazosin Mesylate TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505009600",
      "ndc_label_name": "Doxazosin Mesylate TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651089599",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011009",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135005490",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062860",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762248007",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016016",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083160",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087860",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382078610",
      "ndc_label_name": "Doxazosin Mesylate TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016060",
      "ndc_label_name": "Doxazosin Mesylate Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378104910",
      "ndc_label_name": "Doxepin HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378104901",
      "ndc_label_name": "Doxepin HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053790",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241016701",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904705261",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241016710",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806052910",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155079401",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135056090",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079043601",
      "ndc_label_name": "Doxepin HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335064201",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629322101",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714013201",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806052901",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884021701",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356065030",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315015801",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429096610",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189038830",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469041505",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205053430",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032909",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672421701",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079043620",
      "ndc_label_name": "Doxepin HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189057430",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332063731",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189059030",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053730",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205069530",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651017301",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746070001",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429096601",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789022030",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335209201",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189063330",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756042411",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603039001",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238116609",
      "ndc_label_name": "Doxepin HCl CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980059401",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921016201",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789022090",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035530",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469041501",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033301",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518425200",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033330",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205008891",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789007230",
      "ndc_label_name": "Doxepin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241017101",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238117309",
      "ndc_label_name": "Doxepin HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155079801",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238117301",
      "ndc_label_name": "Doxepin HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904705561",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378641001",
      "ndc_label_name": "Doxepin HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241017110",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378641010",
      "ndc_label_name": "Doxepin HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332064031",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205009291",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315016201",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162222601",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806053301",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651017701",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884022101",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714013601",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756042811",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033701",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603039401",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469041901",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980059801",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079065101",
      "ndc_label_name": "Doxepin HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079065120",
      "ndc_label_name": "Doxepin HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429097010",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469041905",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921016601",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672422101",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162222600",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746070401",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429097001",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135056490",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033730",
      "ndc_label_name": "Doxepin HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799093502",
      "ndc_label_name": "Doxepin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629218001",
      "ndc_label_name": "Doxepin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291024790",
      "ndc_label_name": "Doxepin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799093501",
      "ndc_label_name": "Doxepin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884022205",
      "ndc_label_name": "Doxepin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629218201",
      "ndc_label_name": "Doxepin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799093550",
      "ndc_label_name": "Doxepin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315016301",
      "ndc_label_name": "Doxepin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629218101",
      "ndc_label_name": "Doxepin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315016350",
      "ndc_label_name": "Doxepin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884022203",
      "ndc_label_name": "Doxepin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884022201",
      "ndc_label_name": "Doxepin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315016305",
      "ndc_label_name": "Doxepin HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356042460",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241016801",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378312510",
      "ndc_label_name": "Doxepin HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033109",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378312501",
      "ndc_label_name": "Doxepin HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155079501",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904705361",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289037030",
      "ndc_label_name": "Doxepin HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746070101",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806053010",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806053001",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054110",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714013301",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241016810",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079043720",
      "ndc_label_name": "Doxepin HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651017401",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429096701",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267008430",
      "ndc_label_name": "Doxepin HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033116",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429096710",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079043701",
      "ndc_label_name": "Doxepin HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884021801",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289037090",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919086330",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335255705",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773109",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054160",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135056190",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672421801",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054120",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700091730",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041101",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189053330",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205008991",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332063831",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335281702",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980059501",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054130",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315015901",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469041601",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789054230",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033401",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756042511",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335281703",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238117009",
      "ndc_label_name": "Doxepin HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056760",
      "ndc_label_name": "Doxepin HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061030",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033430",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205075930",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773103",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189016130",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773106",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335281701",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335281704",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603039101",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335281705",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031601",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921016301",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031603",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041102",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031602",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041103",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469041605",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804001130",
      "ndc_label_name": "Doxepin HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079043820",
      "ndc_label_name": "Doxepin HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378425001",
      "ndc_label_name": "Doxepin HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700076830",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241016901",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090395201",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714013401",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033530",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378425010",
      "ndc_label_name": "Doxepin HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746070201",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904705461",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469041705",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241016910",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090718401",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090027801",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959066230",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155079601",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332064531",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884021901",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921016401",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672421901",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205009091",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090781901",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603039201",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090528601",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079043801",
      "ndc_label_name": "Doxepin HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700098230",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092830",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135056290",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429096801",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651017501",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429096810",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315016001",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238117109",
      "ndc_label_name": "Doxepin HCl CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267068030",
      "ndc_label_name": "Doxepin HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008130",
      "ndc_label_name": "Doxepin HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033501",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756042611",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980059601",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469041701",
      "ndc_label_name": "Doxepin HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378537501",
      "ndc_label_name": "Doxepin HCl CAPSULE 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033630",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884022001",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241017001",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714013501",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315016101",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651017601",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155079701",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378537510",
      "ndc_label_name": "Doxepin HCl CAPSULE 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469041801",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238117209",
      "ndc_label_name": "Doxepin HCl CAPSULE 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980059701",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241017010",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756042711",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332063931",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033601",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746070301",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672422001",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429096901",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921016501",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429096910",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205009191",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135056390",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603039301",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469041805",
      "ndc_label_name": "Doxepin HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54838051240",
      "ndc_label_name": "Doxepin HCl Concentrate 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432065104",
      "ndc_label_name": "Doxepin HCl Concentrate 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904042804",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904042806",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748420",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143980305",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748428",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143314250",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808023302",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098820",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012630",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808023301",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090556001",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356054314",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748460",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143980350",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582021618",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090741101",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090246400",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099906",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959005528",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582021605",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012614",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748414",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099920",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268027815",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959005510",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436065101",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090720",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090459900",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268027811",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748430",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012620",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959005500",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335086102",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959005512",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267008506",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090558801",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959005520",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012611",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090260201",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959005502",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335146403",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959005514",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858803",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436022604",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489011902",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090741001",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090459201",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700073290",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335146406",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959005515",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788903702",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959005506",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332036350",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436034103",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090558800",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687051311",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335154908",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700073220",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518162701",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700073214",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187094214",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436110001",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959005530",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072120",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335208602",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687051365",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335146402",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135098505",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187094220",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959005507",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788737102",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008290",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335208603",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081820",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335146405",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332036371",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629153101",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959005590",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858808",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135098550",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335208605",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788903701",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335210003",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187084520",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629153102",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489011905",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238110002",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629153105",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335210004",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004628",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335210006",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858806",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629153107",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700073230",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238110005",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629153106",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027750",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205038520",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335210008",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004620",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788737103",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118314205",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518348804",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858802",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425011402",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205051820",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055920",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335086103",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788737106",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072160",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934008514",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934062520",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425021101",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335146404",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789029814",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335154902",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858801",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629153104",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205038542",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335146401",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934008520",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335146407",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420056210",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335208601",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934081020",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788737101",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335146408",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335208608",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205038514",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335154901",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420056220",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578005505",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205051814",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788737108",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335154900",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335210001",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027720",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335154907",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425021102",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578005518",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036914",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335154903",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335154905",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335210005",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804004620",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335208607",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004420",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420056250",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335154906",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335210007",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189000630",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804004614",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335210002",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055930",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789029820",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036902",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189000620",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028002",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004410",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028003",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004414",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804017914",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420056230",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804017920",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804004606",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028001",
      "ndc_label_name": "Doxycycline Hyclate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489011802",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489011805",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143980250",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135098450",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090538004",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268027711",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143314150",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090002604",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205015620",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289050230",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090621204",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332036250",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135098405",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289050260",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090582504",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55289050216",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205055420",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189005210",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268027715",
      "ndc_label_name": "Doxycycline Hyclate CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335284401",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205065320",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162218602",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578005418",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162218605",
      "ndc_label_name": "Doxycycline Hyclate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143211250",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748205",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748214",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748220",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748239",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748219",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143211205",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378016702",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378016713",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748228",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904043095",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748295",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748291",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748281",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658031001",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658031005",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748230",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748271",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658031220",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658031250",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748292",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658031007",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658031008",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658031021",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904043004",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591555305",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192050105",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386079401",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748297",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658031205",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658031020",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090244609",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658031050",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904043006",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806031005",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002000",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591555350",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808023402",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658031201",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090613305",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658031210",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135054420",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090244601",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090244600",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658031030",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806031050",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386079450",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090613308",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090498106",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658031010",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090244603",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090244605",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808023401",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806031250",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002056",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090754600",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090613301",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806031205",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090244606",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090498100",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386079405",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090002303",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090002305",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090754706",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090754603",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781049105",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090385901",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090498103",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090002300",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090002308",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090498101",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047420",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090758000",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090613303",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002027160",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090603605",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090002301",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090244608",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090498108",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086602",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047414",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090613306",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489012060",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090603608",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090303706",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090498105",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090603600",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086607",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002027100",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090613406",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086608",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090780000",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321800",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090498601",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090603603",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086686",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086695",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489012002",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086614",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268027911",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090603606",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090603601",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090754601",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086693",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760062620",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086604",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086620",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047430",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268027915",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090613300",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090754606",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429006920",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072320",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086606",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086650",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086682",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002027114",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090754605",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086630",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919066720",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135062601",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086610",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086660",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760062660",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002027128",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090754608",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086674",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135062605",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629134802",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821701",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629134803",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760065120",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489012001",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002027120",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086685",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135062610",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747408",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008720",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747403",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135062696",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086628",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489012005",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086687",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135062623",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821703",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578000118",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846401",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747402",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086671",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086698",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760021520",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739016833",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027620",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027628",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999062601",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846403",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086690",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072360",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135062640",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763801",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031928",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031914",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999062610",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335971804",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760065160",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135062612",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763802",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934018720",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804007014",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031930",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205069720",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011730",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135062628",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135062650",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763808",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060320",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135062631",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789041914",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162240202",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027607",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747401",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584069311",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335971801",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027610",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821702",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804017314",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012720",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031906",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846402",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584069321",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027690",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031960",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012714",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85477050105",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027671",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629134801",
      "ndc_label_name": "Doxycycline Hyclate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578000105",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747406",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031907",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763803",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027601",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763806",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027693",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999062696",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027614",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027674",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027682",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027685",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027687",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031910",
      "ndc_label_name": "Doxycycline Hyclate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713057293",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063088620",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713055593",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063088660",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090598401",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713055550",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090239700",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090147201",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884072703",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098514",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713057250",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098502",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135026225",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386079202",
      "ndc_label_name": "Doxycycline Monohydrate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090598300",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090344301",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090483301",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090147200",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700072320",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884072704",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135026250",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386079211",
      "ndc_label_name": "Doxycycline Monohydrate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090678301",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090598301",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187067202",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090344300",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919027620",
      "ndc_label_name": "Doxycycline Monohydrate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687071611",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380092201",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268028115",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919098130",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090598400",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187093620",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090483300",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187067206",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062420",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380092202",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187067220",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084074321",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687071621",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084074311",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090678300",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187071214",
      "ndc_label_name": "Doxycycline Monohydrate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380018002",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180065208",
      "ndc_label_name": "Doxycycline Monohydrate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084074333",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205013530",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062414",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382070718",
      "ndc_label_name": "Doxycycline Monohydrate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919098120",
      "ndc_label_name": "Doxycycline Monohydrate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380018001",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084074332",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061614",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205013514",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335306401",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135026260",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205013506",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332025050",
      "ndc_label_name": "Doxycycline Monohydrate CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335241703",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934049920",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335306400",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019920",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335306402",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187013520",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335306409",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205013502",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335306404",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205013520",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335306407",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019937",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030820",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187093614",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022083",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335306405",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030860",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304061650",
      "ndc_label_name": "Doxycycline Monohydrate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035820",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019960",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049610",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061606",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030837",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335306408",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049620",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061620",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804005010",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025814",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049660",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061630",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804005030",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804005020",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804005006",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335241702",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804005014",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030850",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335306403",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049114",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335306406",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804017120",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004702",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004714",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884072601",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713057001",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268028015",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380092001",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407067801",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386079001",
      "ndc_label_name": "Doxycycline Monohydrate CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382078201",
      "ndc_label_name": "Doxycycline Monohydrate CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135026001",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629218301",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380017901",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407038701",
      "ndc_label_name": "Doxycycline Monohydrate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180065001",
      "ndc_label_name": "Doxycycline Monohydrate CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090380900",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527133825",
      "ndc_label_name": "Doxycycline Monohydrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155013505",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700012220",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527133850",
      "ndc_label_name": "Doxycycline Monohydrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629135702",
      "ndc_label_name": "Doxycycline Monohydrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291015625",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380020701",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687034425",
      "ndc_label_name": "Doxycycline Monohydrate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291015605",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687034495",
      "ndc_label_name": "Doxycycline Monohydrate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934080820",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155013525",
      "ndc_label_name": "Doxycycline Monohydrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710112307",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090146200",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804002820",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135072620",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919047420",
      "ndc_label_name": "Doxycycline Monohydrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178700",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629135701",
      "ndc_label_name": "Doxycycline Monohydrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629135703",
      "ndc_label_name": "Doxycycline Monohydrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304013204",
      "ndc_label_name": "Doxycycline Monohydrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031903",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934032520",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031902",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031901",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804002814",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008003120",
      "ndc_label_name": "Doxycycline Monohydrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00085014711",
      "ndc_label_name": "Drixoral Cold/Allergy Tablet Extended Release 12 Hour 6-120 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00085014703",
      "ndc_label_name": "Drixoral Cold/Allergy Tablet Extended Release 12 Hour 6-120 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "75834011584",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol TABLET 3-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180090211",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol Tablet 3-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378730053",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol TABLET 3-0.03 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505418301",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol Tablet 3-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180086873",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol Tablet 3-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722094531",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol Tablet 3-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722094532",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol Tablet 3-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180090273",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol Tablet 3-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180090271",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol Tablet 3-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180090213",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol Tablet 3-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629233501",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol Tablet 3-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462073329",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol TABLET 3-0.03 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462073384",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol TABLET 3-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090249400",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol Tablet 3-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834011529",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol TABLET 3-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180086871",
      "ndc_label_name": "Drospirenone-Ethinyl Estradiol Tablet 3-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70000050202",
      "ndc_label_name": "Dry Eye Relief Drops Solution 0.2-0.2-1 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000050201",
      "ndc_label_name": "Dry Eye Relief Drops Solution 0.2-0.2-1 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00096070760",
      "ndc_label_name": "Drysol SOLUTION 20 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00096070737",
      "ndc_label_name": "Drysol SOLUTION 20 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00096070735",
      "ndc_label_name": "Drysol SOLUTION 20 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356024737",
      "ndc_label_name": "Drysol Solution 20 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904704304",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440749030",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010960",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228289006",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440749007",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704361",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440749060",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010683",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268026911",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483071350",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722058160",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241009706",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440749090",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241009710",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483071306",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547037906",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268028615",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090302800",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010674",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722016860",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010633",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010616",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090640601",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090688900",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991074690",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090640600",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090688901",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342016009",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547037909",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335038188",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072311",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090781201",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237001760",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237001799",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268028611",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483071309",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991074605",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483071301",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180029406",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429016460",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919042230",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063660",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505299506",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436450202",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072321",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090781200",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205052530",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638000",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001059406",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084067511",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919042260",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700072760",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760075930",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268026915",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095774",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638009",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789706",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180029407",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629199001",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063620",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180029403",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081760",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189063430",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335016503",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000530",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638003",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877026360",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084067521",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638001",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700072730",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001041306",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162159705",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335016501",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638006",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382038514",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097029703",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162159709",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789703",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788638002",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031102",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073933",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073916",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335016502",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063301",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063390",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789709",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063330",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009017010",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009002905",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063360",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031101",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000560",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040183",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073974",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031103",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440749160",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440749190",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241009809",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722058290",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228289103",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704461",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228289150",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440749130",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722016930",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483071401",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547038003",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096030",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440749107",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241009810",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011005",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087790",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483071410",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251701",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547038011",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268028711",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722058230",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096042",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011030",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547038009",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090280700",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090690000",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251700",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436001801",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483071403",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090689900",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241009803",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335038288",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320500",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268027013",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090331700",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991074710",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090628101",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436019801",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096083",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268027011",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090604000",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081830",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090778400",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048230",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081890",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060560",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483071409",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060530",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090628100",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237001899",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436019802",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048290",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760095160",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237001830",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320501",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429016590",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268028713",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505299603",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991074790",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629517401",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187070260",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237001890",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090689901",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187070230",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436074702",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760046160",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877026490",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629517404",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001041404",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429016530",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436001802",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187070290",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760046130",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048260",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084068301",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001059505",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180029509",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073411",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436074701",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782801",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187017230",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629517402",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402506",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001059508",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761903",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629199101",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073401",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860803",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629517403",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877026410",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782802",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382038606",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761906",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877026430",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187017260",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788930101",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084068311",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001059504",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860809",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382038616",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782803",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001041405",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187061230",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205060290",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402503",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761909",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788930100",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761902",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788793509",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001041408",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187061260",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335167201",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761900",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782806",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788930103",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097029802",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788930106",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180029503",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629517405",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335253705",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782800",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782809",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205044530",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518105406",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788930109",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402509",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180029506",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063401",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205044590",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788793503",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205044560",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023630",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934072930",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788930102",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761901",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009003010",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335167202",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788793506",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335167205",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008602",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335201702",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095453",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335201701",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008004630",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335253701",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860806",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335201705",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425044102",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095460",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205060230",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335253702",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425044103",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061590",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205060260",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061530",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008004660",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162159809",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021860",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021830",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001402",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023690",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014601",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189066160",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425044101",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061560",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040260",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063460",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063490",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023660",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073642",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001201",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001301",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001302",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095430",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008601",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014602",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014603",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063430",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001202",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001401",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009017110",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440749290",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722017030",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440749207",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228289203",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228289296",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704561",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547038103",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011130",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722058330",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002530",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440749230",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342016244",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440749260",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011105",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090222600",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241009903",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090677500",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002560",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090284400",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002553",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342016207",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241009990",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090258500",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090258501",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090677501",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483071509",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429016630",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483071503",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483071501",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547038109",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436019902",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237001999",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090689300",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090594000",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760046260",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090222601",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483071510",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547038111",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436074801",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048330",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436001901",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268027111",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187018130",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090594001",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268027113",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090789700",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760055930",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629520204",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700062860",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436289201",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001041508",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268028813",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436038701",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268028811",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004290",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084069201",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004230",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081910",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402609",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436019901",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436074802",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991074810",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187066630",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402603",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877026530",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700062830",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862309",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436019903",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436074803",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991074890",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073530",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767209",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767203",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505299703",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335040204",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700062890",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436299701",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237001930",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629520201",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862306",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767208",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187045730",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074330",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687074501",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081930",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760046230",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629520202",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335040201",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205035860",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187066660",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074374",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687074511",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237001990",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073560",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629874801",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074360",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033890",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335144501",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420062301",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004260",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429016610",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073590",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382038706",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074380",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008004030",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040353",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425011902",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629520203",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629199201",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877026510",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862303",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420062330",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001041504",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040360",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009003210",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877026590",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001059604",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001041505",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335050904",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038902",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335256701",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074353",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335256703",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767200",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162159901",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001059608",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038903",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767202",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060860",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162159909",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420062390",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097029902",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038901",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084069211",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205035830",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425011901",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060890",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180029603",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420062360",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180029606",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008004060",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180029609",
      "ndc_label_name": "DULoxetine HCl CAPSULE DELAYED RELEASE PARTICLES 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402606",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767201",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767206",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518093703",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335040203",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060830",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425011903",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009017310",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008004090",
      "ndc_label_name": "DULoxetine HCl Capsule Delayed Release Particles 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11917005135",
      "ndc_label_name": "Ear Drops SOLUTION 6.5 % OTIC",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904662735",
      "ndc_label_name": "Ear Drops Solution 6.5 % Otic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090527300",
      "ndc_label_name": "Ear Drops Solution 6.5 % Otic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49614020405",
      "ndc_label_name": "Ear Drops Solution 6.5 % Otic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53681000719",
      "ndc_label_name": "Easy Flow 300 MM Hose",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000720",
      "ndc_label_name": "Easy Flow 400 MM Hose",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000721",
      "ndc_label_name": "Easy Flow Air Nozzle",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000705",
      "ndc_label_name": "Easy Flow HEPA Filter",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53681000711",
      "ndc_label_name": "Easy Flow HEPA Filter",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363000260",
      "ndc_label_name": "Easy-Lax Plus TABLET 8.6-50 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917005318",
      "ndc_label_name": "Easy-Lax Plus TABLET 8.6-50 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363000220",
      "ndc_label_name": "Easy-Lax Plus TABLET 8.6-50 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00485005708",
      "ndc_label_name": "Ed-APAP Liquid 160 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59676027801",
      "ndc_label_name": "Edurant Tablet 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980040709",
      "ndc_label_name": "Efavirenz Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980040603",
      "ndc_label_name": "Efavirenz Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862049730",
      "ndc_label_name": "Efavirenz-Emtricitab-Tenofo DF Tablet 600-200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067830",
      "ndc_label_name": "Efavirenz-Emtricitab-Tenofo DF Tablet 600-200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722073630",
      "ndc_label_name": "Efavirenz-Emtricitab-Tenofo DF Tablet 600-200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093523456",
      "ndc_label_name": "Efavirenz-Emtricitab-Tenofo DF Tablet 600-200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342013807",
      "ndc_label_name": "Efavirenz-Emtricitab-Tenofo DF Tablet 600-200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385091530",
      "ndc_label_name": "Efavirenz-Emtricitab-Tenofo DF Tablet 600-200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162256503",
      "ndc_label_name": "Efavirenz-Emtricitab-Tenofo DF Tablet 600-200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097021002",
      "ndc_label_name": "Efavirenz-Emtricitab-Tenofo DF Tablet 600-200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385092931",
      "ndc_label_name": "Efavirenz-lamiVUDine-Tenofovir Tablet 400-300-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385092830",
      "ndc_label_name": "Efavirenz-lamiVUDine-Tenofovir Tablet 600-300-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54092070001",
      "ndc_label_name": "Elaprase SOLUTION 6 MG/3ML Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00187510102",
      "ndc_label_name": "Elidel Cream 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187510001",
      "ndc_label_name": "Elidel Cream 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356022300",
      "ndc_label_name": "Elidel Cream 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187510203",
      "ndc_label_name": "Elidel Cream 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118995203",
      "ndc_label_name": "Elidel Cream 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62935022305",
      "ndc_label_name": "Eligard Kit 22.5 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62935022710",
      "ndc_label_name": "Eligard Kit 22.5 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62935030640",
      "ndc_label_name": "Eligard Kit 30 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62935030330",
      "ndc_label_name": "Eligard Kit 30 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62935046150",
      "ndc_label_name": "Eligard Kit 45 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62935045345",
      "ndc_label_name": "Eligard Kit 45 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62935075680",
      "ndc_label_name": "Eligard Kit 7.5 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62935075375",
      "ndc_label_name": "Eligard Kit 7.5 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00003376474",
      "ndc_label_name": "Eliquis DVT/PE Starter Pack Tablet Therapy Pack 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090283500",
      "ndc_label_name": "Ella Tablet 30 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090542200",
      "ndc_label_name": "Ella Tablet 30 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73302045601",
      "ndc_label_name": "Ella Tablet 30 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50102091101",
      "ndc_label_name": "Ella Tablet 30 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002311501",
      "ndc_label_name": "Emgality (300 MG Dose) Solution Prefilled Syringe 100 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002311509",
      "ndc_label_name": "Emgality (300 MG Dose) Solution Prefilled Syringe 100 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002143601",
      "ndc_label_name": "Emgality Solution Auto-Injector 120 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002143611",
      "ndc_label_name": "Emgality Solution Auto-Injector 120 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002237711",
      "ndc_label_name": "Emgality Solution Prefilled Syringe 120 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002237701",
      "ndc_label_name": "Emgality Solution Prefilled Syringe 120 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291043930",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385095330",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093770456",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291098030",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378193093",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342010607",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714053401",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687071995",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090595701",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771901",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904717207",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090649401",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505420203",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180028706",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722056030",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031203",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097074102",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407011230",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543071904",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687071925",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009010930",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238209503",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710136703",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862035430",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189015602",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380071904",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067730",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022702",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040303",
      "ndc_label_name": "Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356020530",
      "ndc_label_name": "Emtriva Capsule 200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958060101",
      "ndc_label_name": "Emtriva Capsule 200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958060201",
      "ndc_label_name": "Emtriva SOLUTION 10 MG/ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238214107",
      "ndc_label_name": "Enalapril Maleate Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52536040101",
      "ndc_label_name": "Enalapril Maleate Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452023746",
      "ndc_label_name": "Enalapril Maleate Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238172907",
      "ndc_label_name": "Enalapril Maleate Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651052955",
      "ndc_label_name": "Enalapril Maleate Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722002015",
      "ndc_label_name": "Enalapril Maleate Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603024701",
      "ndc_label_name": "Enalapril Maleate Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904731161",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714044401",
      "ndc_label_name": "Enalapril Maleate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090597600",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547054710",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748730",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090327500",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714044402",
      "ndc_label_name": "Enalapril Maleate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090327504",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090069001",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547054711",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090671200",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090327501",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748790",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090671201",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155077210",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767801",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407082810",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403901",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672424503",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767800",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904561061",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090671204",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090069000",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672424501",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092502",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959018060",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092503",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767804",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155077201",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228023001",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429018510",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959018030",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092509",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289059190",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767109",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228023010",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090069004",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407082890",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267100900",
      "ndc_label_name": "Enalapril Maleate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092510",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796706",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429018590",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838509",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289059130",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403903",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152601",
      "ndc_label_name": "Enalapril Maleate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724409",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980068701",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838503",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919027730",
      "ndc_label_name": "Enalapril Maleate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292054401",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135059190",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66685030300",
      "ndc_label_name": "Enalapril Maleate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724403",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767106",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980068710",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934052690",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919027790",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292054410",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152602",
      "ndc_label_name": "Enalapril Maleate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934070230",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838506",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682071201",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152603",
      "ndc_label_name": "Enalapril Maleate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645045690",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205007590",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767101",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267032391",
      "ndc_label_name": "Enalapril Maleate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645060690",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189015190",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796701",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767103",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682071210",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796709",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838501",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724401",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003190",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724406",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032990",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796703",
      "ndc_label_name": "Enalapril Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155070410",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714044201",
      "ndc_label_name": "Enalapril Maleate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090285500",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748590",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403701",
      "ndc_label_name": "Enalapril Maleate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547054510",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904730961",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081330",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547054511",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228022810",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403703",
      "ndc_label_name": "Enalapril Maleate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904560961",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081390",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028290",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155070401",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092303",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429018390",
      "ndc_label_name": "Enalapril Maleate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714044202",
      "ndc_label_name": "Enalapril Maleate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980068501",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429018310",
      "ndc_label_name": "Enalapril Maleate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028230",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092309",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228022801",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980068510",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092310",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292054001",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135058990",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629789501",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092302",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682071001",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682071010",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292054010",
      "ndc_label_name": "Enalapril Maleate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090643700",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904561161",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353052180",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748890",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714044501",
      "ndc_label_name": "Enalapril Maleate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155077305",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904731261",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090688100",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090688101",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714044502",
      "ndc_label_name": "Enalapril Maleate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289098490",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353052160",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999034500",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547054811",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155077310",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090688103",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289098430",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155077301",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760022630",
      "ndc_label_name": "Enalapril Maleate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228023101",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090069201",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090069203",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090456001",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767700",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919069030",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547054810",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187097790",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404001",
      "ndc_label_name": "Enalapril Maleate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090643703",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090456000",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767703",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767701",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135059290",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999034530",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934049290",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959094230",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092602",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090456003",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092609",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980068801",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980068810",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090069200",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645045790",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760057530",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832006",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090643701",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832001",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66685030402",
      "ndc_label_name": "Enalapril Maleate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66685030400",
      "ndc_label_name": "Enalapril Maleate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228023110",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645060790",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267038091",
      "ndc_label_name": "Enalapril Maleate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788730909",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429018610",
      "ndc_label_name": "Enalapril Maleate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292054610",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682071310",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404003",
      "ndc_label_name": "Enalapril Maleate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682071301",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429018690",
      "ndc_label_name": "Enalapril Maleate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788730901",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039730",
      "ndc_label_name": "Enalapril Maleate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788730903",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760039230",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788730906",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092610",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031890",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092603",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832003",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292054601",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832009",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934049230",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934068930",
      "ndc_label_name": "Enalapril Maleate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748610",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748690",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904550261",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748691",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748660",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316601",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440748630",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090649000",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904731061",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714044302",
      "ndc_label_name": "Enalapril Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090337801",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714044301",
      "ndc_label_name": "Enalapril Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999023900",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090649003",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904570161",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090649001",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155070510",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090337800",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090730200",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999023960",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090722201",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090722200",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155070501",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403803",
      "ndc_label_name": "Enalapril Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547054611",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090337803",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760058730",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090068901",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090730201",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228022901",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547054610",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135059090",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090068900",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152201",
      "ndc_label_name": "Enalapril Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760077730",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090529201",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429018490",
      "ndc_label_name": "Enalapril Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289069490",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999023930",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267041392",
      "ndc_label_name": "Enalapril Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090722203",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152202",
      "ndc_label_name": "Enalapril Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267041360",
      "ndc_label_name": "Enalapril Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228022910",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682071110",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828406",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289069430",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645060590",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090730203",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092409",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66685030200",
      "ndc_label_name": "Enalapril Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289069410",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292054210",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092410",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760068830",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828403",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403801",
      "ndc_label_name": "Enalapril Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788727501",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292054201",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429018410",
      "ndc_label_name": "Enalapril Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037230",
      "ndc_label_name": "Enalapril Maleate TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788727506",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037290",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843706",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152203",
      "ndc_label_name": "Enalapril Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809603",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092403",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629152204",
      "ndc_label_name": "Enalapril Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980068610",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809606",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980068601",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679092402",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682071101",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809609",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66685030202",
      "ndc_label_name": "Enalapril Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645045590",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828409",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843703",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788727503",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828401",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205007490",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843709",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788727509",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809601",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843701",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934071390",
      "ndc_label_name": "Enalapril Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999082300",
      "ndc_label_name": "Enalapril-Hydrochlorothiazide Tablet 10-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404601",
      "ndc_label_name": "Enalapril-Hydrochlorothiazide TABLET 10-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111013301",
      "ndc_label_name": "Enalapril-Hydrochlorothiazide TABLET 5-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672404501",
      "ndc_label_name": "Enalapril-Hydrochlorothiazide TABLET 5-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58406004404",
      "ndc_label_name": "Enbrel Mini Solution Cartridge 50 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58406004401",
      "ndc_label_name": "Enbrel Mini Solution Cartridge 50 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58406005501",
      "ndc_label_name": "Enbrel Solution 25 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58406005504",
      "ndc_label_name": "Enbrel Solution 25 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58406001004",
      "ndc_label_name": "Enbrel Solution Prefilled Syringe 25 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58406001001",
      "ndc_label_name": "Enbrel Solution Prefilled Syringe 25 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58406002101",
      "ndc_label_name": "Enbrel Solution Prefilled Syringe 50 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58406002104",
      "ndc_label_name": "Enbrel Solution Prefilled Syringe 50 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58406042541",
      "ndc_label_name": "Enbrel Solution Reconstituted 25 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58406042534",
      "ndc_label_name": "Enbrel Solution Reconstituted 25 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58406003204",
      "ndc_label_name": "Enbrel SureClick Solution Auto-Injector 50 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090459000",
      "ndc_label_name": "Enbrel SureClick Solution Auto-Injector 50 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58406003201",
      "ndc_label_name": "Enbrel SureClick Solution Auto-Injector 50 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11917014777",
      "ndc_label_name": "Enema Mineral Oil ENEMA Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007645",
      "ndc_label_name": "Enema Mineral Oil ENEMA Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000010901",
      "ndc_label_name": "Enema Mineral Oil Enema Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58160082101",
      "ndc_label_name": "Engerix-B Suspension 20 MCG/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082043",
      "ndc_label_name": "Engerix-B Suspension Prefilled Syringe 10 MCG/0.5ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00955101601",
      "ndc_label_name": "Enoxaparin Sodium SOLUTION 300 MG/3ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001046441",
      "ndc_label_name": "Enoxaparin Sodium Solution 300 MG/3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323053903",
      "ndc_label_name": "Enoxaparin Sodium Solution 300 MG/3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00548560800",
      "ndc_label_name": "Enoxaparin Sodium Solution 300 MG/3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001064141",
      "ndc_label_name": "Enoxaparin Sodium Solution 300 MG/3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288042691",
      "ndc_label_name": "Enoxaparin Sodium Solution 300 MG/3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288042603",
      "ndc_label_name": "Enoxaparin Sodium Solution 300 MG/3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555904758",
      "ndc_label_name": "Enpresse-28 Tablet 50-30/75-40/ 125-30 MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527183037",
      "ndc_label_name": "Entacapone Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904682204",
      "ndc_label_name": "Entacapone Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335000788",
      "ndc_label_name": "Entacapone TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378908001",
      "ndc_label_name": "Entacapone Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079027303",
      "ndc_label_name": "Entacapone Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342026011",
      "ndc_label_name": "Entacapone TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781557801",
      "ndc_label_name": "Entacapone TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099605",
      "ndc_label_name": "Entacapone Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024783",
      "ndc_label_name": "Entacapone Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862065401",
      "ndc_label_name": "Entacapone TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904682207",
      "ndc_label_name": "Entacapone Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353085518",
      "ndc_label_name": "Entacapone Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241004910",
      "ndc_label_name": "Entacapone TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099683",
      "ndc_label_name": "Entacapone Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353093205",
      "ndc_label_name": "Entacapone Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268029511",
      "ndc_label_name": "Entacapone TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687018821",
      "ndc_label_name": "Entacapone TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268029515",
      "ndc_label_name": "Entacapone TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679078102",
      "ndc_label_name": "Entacapone Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332047831",
      "ndc_label_name": "Entacapone Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079027301",
      "ndc_label_name": "Entacapone Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687018811",
      "ndc_label_name": "Entacapone TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135061530",
      "ndc_label_name": "Entecavir TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722083330",
      "ndc_label_name": "Entecavir TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547043603",
      "ndc_label_name": "Entecavir Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991089533",
      "ndc_label_name": "Entecavir Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021695",
      "ndc_label_name": "Entecavir TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729038810",
      "ndc_label_name": "Entecavir Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714071701",
      "ndc_label_name": "Entecavir TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407006430",
      "ndc_label_name": "Entecavir Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291026130",
      "ndc_label_name": "Entecavir Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268028911",
      "ndc_label_name": "Entecavir Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021625",
      "ndc_label_name": "Entecavir TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382092006",
      "ndc_label_name": "Entecavir TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442031130",
      "ndc_label_name": "Entecavir Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862084130",
      "ndc_label_name": "Entecavir TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722083390",
      "ndc_label_name": "Entecavir TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806065830",
      "ndc_label_name": "Entecavir Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097042602",
      "ndc_label_name": "Entecavir Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268028912",
      "ndc_label_name": "Entecavir Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42494045730",
      "ndc_label_name": "Entecavir Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407058930",
      "ndc_label_name": "Entecavir Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921019433",
      "ndc_label_name": "Entecavir Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135061630",
      "ndc_label_name": "Entecavir TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714071801",
      "ndc_label_name": "Entecavir TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382092106",
      "ndc_label_name": "Entecavir TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806065930",
      "ndc_label_name": "Entecavir Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862084230",
      "ndc_label_name": "Entecavir TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291026230",
      "ndc_label_name": "Entecavir Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729038910",
      "ndc_label_name": "Entecavir Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722083430",
      "ndc_label_name": "Entecavir TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991089633",
      "ndc_label_name": "Entecavir Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547043703",
      "ndc_label_name": "Entecavir Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097042502",
      "ndc_label_name": "Entecavir Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42494045830",
      "ndc_label_name": "Entecavir Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921019533",
      "ndc_label_name": "Entecavir Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407006530",
      "ndc_label_name": "Entecavir Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078123820",
      "ndc_label_name": "Entresto Capsule Sprinkle 15-16 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078123120",
      "ndc_label_name": "Entresto Capsule Sprinkle 6-6 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081089",
      "ndc_label_name": "Entresto Tablet 24-26 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610081088",
      "ndc_label_name": "Entresto Tablet 24-26 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610081032",
      "ndc_label_name": "Entresto Tablet 24-26 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078065920",
      "ndc_label_name": "Entresto Tablet 24-26 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078065967",
      "ndc_label_name": "Entresto Tablet 24-26 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610080632",
      "ndc_label_name": "Entresto Tablet 49-51 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078077767",
      "ndc_label_name": "Entresto Tablet 49-51 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078077720",
      "ndc_label_name": "Entresto Tablet 49-51 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610080737",
      "ndc_label_name": "Entresto Tablet 97-103 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078069667",
      "ndc_label_name": "Entresto Tablet 97-103 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078069620",
      "ndc_label_name": "Entresto Tablet 97-103 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68992307501",
      "ndc_label_name": "Envarsus XR Tablet Extended Release 24 Hour 0.75 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68992307503",
      "ndc_label_name": "Envarsus XR Tablet Extended Release 24 Hour 0.75 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68992301003",
      "ndc_label_name": "Envarsus XR Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68992301001",
      "ndc_label_name": "Envarsus XR Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68992304001",
      "ndc_label_name": "Envarsus XR Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68992304003",
      "ndc_label_name": "Envarsus XR Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517117110",
      "ndc_label_name": "EPINEPHrine (Anaphylaxis) Solution 1 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517117101",
      "ndc_label_name": "EPINEPHrine (Anaphylaxis) Solution 1 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329906000",
      "ndc_label_name": "EPINEPHrine (Anaphylaxis) Solution 30 MG/30ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288015401",
      "ndc_label_name": "EPINEPHrine HCl (Nasal) Solution 0.1 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288012301",
      "ndc_label_name": "EPINEPHrine HCl (Nasal) Solution 0.1 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288010310",
      "ndc_label_name": "EPINEPHrine PF Solution 1 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288010301",
      "ndc_label_name": "EPINEPHrine PF Solution 1 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374030610",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/10ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288060001",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288012001",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54288015201",
      "ndc_label_name": "EPINEPHrine Solution 1 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115169530",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.15 MG/0.15ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115169549",
      "ndc_label_name": "EPINEPHrine Solution Auto-injector 0.15 MG/0.15ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093598519",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.15 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093598527",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.15 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090273400",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.15 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502010101",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.15 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090525400",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.15 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502010102",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.15 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629880101",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.15 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093598627",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.3 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115169449",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.3 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093598619",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.3 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291042502",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.3 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518204800",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.3 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502010202",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.3 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502010201",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.3 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115169430",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.3 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090315500",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.3 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518228300",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.3 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090273300",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.3 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425026401",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.3 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090454300",
      "ndc_label_name": "EPINEPHrine Solution Auto-Injector 0.3 MG/0.3ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71300662402",
      "ndc_label_name": "EPINEPHrine Solution Prefilled Syringe 0.2 MG/0.2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409493311",
      "ndc_label_name": "EPINEPHrine Solution Prefilled Syringe 1 MG/10ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409493301",
      "ndc_label_name": "EPINEPHrine Solution Prefilled Syringe 1 MG/10ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329331801",
      "ndc_label_name": "EPINEPHrine Solution Prefilled Syringe 1 MG/10ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266812001",
      "ndc_label_name": "EPINEPHrine Solution Prefilled Syringe 1 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923072630",
      "ndc_label_name": "Erlotinib HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332056630",
      "ndc_label_name": "Erlotinib HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991089133",
      "ndc_label_name": "Erlotinib HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378713293",
      "ndc_label_name": "Erlotinib HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72485021830",
      "ndc_label_name": "Erlotinib HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382091406",
      "ndc_label_name": "Erlotinib HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093766356",
      "ndc_label_name": "Erlotinib HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205008130",
      "ndc_label_name": "Erlotinib HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304009630",
      "ndc_label_name": "Erlotinib HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722026430",
      "ndc_label_name": "Erlotinib HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382091506",
      "ndc_label_name": "Erlotinib HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093766456",
      "ndc_label_name": "Erlotinib HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991089233",
      "ndc_label_name": "Erlotinib HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378713393",
      "ndc_label_name": "Erlotinib HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59923072730",
      "ndc_label_name": "Erlotinib HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722026530",
      "ndc_label_name": "Erlotinib HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205008230",
      "ndc_label_name": "Erlotinib HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332056730",
      "ndc_label_name": "Erlotinib HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304013530",
      "ndc_label_name": "Erlotinib HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72485021930",
      "ndc_label_name": "Erlotinib HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991089033",
      "ndc_label_name": "Erlotinib HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378713193",
      "ndc_label_name": "Erlotinib HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332056530",
      "ndc_label_name": "Erlotinib HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093766256",
      "ndc_label_name": "Erlotinib HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59923072530",
      "ndc_label_name": "Erlotinib HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722026330",
      "ndc_label_name": "Erlotinib HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304009530",
      "ndc_label_name": "Erlotinib HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205008030",
      "ndc_label_name": "Erlotinib HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72485021730",
      "ndc_label_name": "Erlotinib HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382091306",
      "ndc_label_name": "Erlotinib HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559044001",
      "ndc_label_name": "Erythromycin Ethylsuccinate Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52536013613",
      "ndc_label_name": "Erythromycin Ethylsuccinate SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238150301",
      "ndc_label_name": "Erythromycin Ethylsuccinate Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52536013213",
      "ndc_label_name": "Erythromycin Ethylsuccinate Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834029501",
      "ndc_label_name": "Erythromycin Ethylsuccinate Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52536013413",
      "ndc_label_name": "Erythromycin Ethylsuccinate SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559063001",
      "ndc_label_name": "Erythromycin Ethylsuccinate Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219150301",
      "ndc_label_name": "Erythromycin Ethylsuccinate Suspension Reconstituted 200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559044002",
      "ndc_label_name": "Erythromycin Ethylsuccinate SUSPENSION RECONSTITUTED 200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478007031",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574402411",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574402435",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574402450",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478007035",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208091055",
      "ndc_label_name": "Erythromycin OINTMENT 5 MG/GM OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574402439",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090195800",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420019603",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208091019",
      "ndc_label_name": "Erythromycin OINTMENT 5 MG/GM OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187060835",
      "ndc_label_name": "Erythromycin OINTMENT 5 MG/GM OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760067035",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959030100",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788851603",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "48102005711",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187026735",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002090559",
      "ndc_label_name": "Erythromycin OINTMENT 5 MG/GM OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356053501",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189003635",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919009035",
      "ndc_label_name": "Erythromycin OINTMENT 5 MG/GM OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788407003",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205026535",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267097535",
      "ndc_label_name": "Erythromycin OINTMENT 5 MG/GM OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090024800",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420021230",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090148400",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485067031",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118002703",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485067035",
      "ndc_label_name": "Erythromycin Ointment 5 MG/GM Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999021760",
      "ndc_label_name": "Erythromycin Solution 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571038425",
      "ndc_label_name": "Erythromycin Solution 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162207506",
      "ndc_label_name": "Erythromycin Solution 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999075260",
      "ndc_label_name": "Erythromycin Solution 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802003846",
      "ndc_label_name": "Erythromycin SOLUTION 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432067160",
      "ndc_label_name": "Erythromycin Solution 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002083883",
      "ndc_label_name": "Erythromycin SOLUTION 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71656003060",
      "ndc_label_name": "Erythromycin Solution 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121085210",
      "ndc_label_name": "Escitalopram Oxalate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999072910",
      "ndc_label_name": "Escitalopram Oxalate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862024824",
      "ndc_label_name": "Escitalopram Oxalate SOLUTION 5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121085240",
      "ndc_label_name": "Escitalopram Oxalate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162070588",
      "ndc_label_name": "Escitalopram Oxalate SOLUTION 5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571076924",
      "ndc_label_name": "Escitalopram Oxalate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135072937",
      "ndc_label_name": "Escitalopram Oxalate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342005328",
      "ndc_label_name": "Escitalopram Oxalate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999072924",
      "ndc_label_name": "Escitalopram Oxalate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722056924",
      "ndc_label_name": "Escitalopram Oxalate SOLUTION 5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672134801",
      "ndc_label_name": "Escitalopram Oxalate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54838055170",
      "ndc_label_name": "Escitalopram Oxalate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904642661",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063076190",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550581",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440750530",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013605",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550500",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550585",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063076130",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063076101",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090570400",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729016917",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090127900",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571075610",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550530",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550590",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547028111",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547028110",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090619001",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090570301",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090570300",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090570500",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550560",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571075601",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090219601",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090336001",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090619100",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090649600",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090619000",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090649601",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013601",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090127901",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090336000",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700084790",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458089216",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760089530",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700084760",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862037401",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013610",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090219600",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746028001",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084061701",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013960",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013990",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001059208",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862037405",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729016901",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090275200",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746028010",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788751009",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001045500",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001059200",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791201",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788697801",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645051954",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700084730",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013930",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837101",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788751003",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180013501",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837103",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791206",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788697809",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760089590",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919085930",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084815",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788751006",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788751001",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205034430",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840303",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837108",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788697803",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919085960",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282025030",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837106",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791209",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205034460",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840309",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837109",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788697806",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001045508",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006030",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840306",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840308",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335118704",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934011230",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934016330",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788697808",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084061711",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934063030",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016860",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856903",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282025090",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016830",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079260",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791203",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788751008",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162224101",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042430",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934011290",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032003",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015001",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282025010",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840301",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084805",
      "ndc_label_name": "Escitalopram Oxalate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032002",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032001",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335118703",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425037501",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009003610",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425037503",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205078230",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934063090",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019430",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425037502",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205078260",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016890",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019490",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032201",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079230",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335118701",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162224100",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335290301",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006590",
      "ndc_label_name": "Escitalopram Oxalate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013701",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090269900",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550681",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571075710",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547028211",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550630",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550660",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550600",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193000",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090653400",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090193001",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729017001",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333100",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904642761",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550685",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550690",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090602301",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090720000",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090583000",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729017017",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655028426",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013710",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013705",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066130",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090602500",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919065290",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436017001",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547028210",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746106",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571075701",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090583100",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090583001",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090720001",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187028130",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862037505",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333101",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746109",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066190",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090653401",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090602300",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746028110",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187028190",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084061811",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090689700",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934008930",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090720100",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458089116",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436005401",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746028190",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001059308",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746103",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760039390",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042560",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059090",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081830",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081890",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645052054",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084915",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746108",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001059300",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189043890",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919065230",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746028101",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919065260",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084905",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019330",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872309",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084061801",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189045190",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180013601",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760017090",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001045600",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934034890",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335130701",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205075330",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872301",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015101",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746101",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862037501",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872306",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205032590",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335130704",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053460",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189045130",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282025110",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872303",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001045608",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934034830",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162224001",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335233104",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335296001",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282025130",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031190",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872308",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189043830",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934065090",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189045160",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282025190",
      "ndc_label_name": "Escitalopram Oxalate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205032530",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019390",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031130",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006430",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006490",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335233103",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162224000",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009003710",
      "ndc_label_name": "Escitalopram Oxalate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862037305",
      "ndc_label_name": "Escitalopram Oxalate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550400",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550430",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550490",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013510",
      "ndc_label_name": "Escitalopram Oxalate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550485",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013501",
      "ndc_label_name": "Escitalopram Oxalate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013505",
      "ndc_label_name": "Escitalopram Oxalate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001059100",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550460",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746027901",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090531200",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571075510",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090717700",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571075501",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729016801",
      "ndc_label_name": "Escitalopram Oxalate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335246003",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440550481",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788755901",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862037301",
      "ndc_label_name": "Escitalopram Oxalate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090436300",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687086501",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547028010",
      "ndc_label_name": "Escitalopram Oxalate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729016817",
      "ndc_label_name": "Escitalopram Oxalate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162224201",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687086511",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282024910",
      "ndc_label_name": "Escitalopram Oxalate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180013701",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090531201",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760089430",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547028011",
      "ndc_label_name": "Escitalopram Oxalate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084705",
      "ndc_label_name": "Escitalopram Oxalate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282024930",
      "ndc_label_name": "Escitalopram Oxalate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001045400",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162224200",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788755908",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090717701",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084715",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603014901",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009003510",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099330",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788755903",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282024990",
      "ndc_label_name": "Escitalopram Oxalate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205031330",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746027910",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335968702",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934064630",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335968703",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205031390",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788755906",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335968701",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788755909",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335246001",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044930",
      "ndc_label_name": "Escitalopram Oxalate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378235093",
      "ndc_label_name": "Esomeprazole Magnesium CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598040727",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660002744",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00093645098",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571088042",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917018956",
      "ndc_label_name": "Esomeprazole Magnesium CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00378235077",
      "ndc_label_name": "Esomeprazole Magnesium CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093645056",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11917018955",
      "ndc_label_name": "Esomeprazole Magnesium CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090302300",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58602080961",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "13668015410",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292000916",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571088041",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16714097901",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00186038290",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714097902",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651056130",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175082032",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668015490",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547000103",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598050990",
      "ndc_label_name": "Esomeprazole Magnesium CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722057230",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668015430",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598050930",
      "ndc_label_name": "Esomeprazole Magnesium CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187096460",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629565901",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722057290",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598050910",
      "ndc_label_name": "Esomeprazole Magnesium CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090621301",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722066410",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722057210",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187096430",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851106",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980063203",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598040733",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090621300",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51660002727",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "31722066430",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292000901",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304073410",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788859701",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877057130",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598040752",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55700088930",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919078930",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722066490",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306501",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862078330",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69230032033",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68382044110",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090302301",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919078960",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877047890",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090619800",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407074210",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877047810",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69618005642",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788761503",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090619801",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761501",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382044116",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304073430",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175082046",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462039010",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70000003203",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788791303",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175082043",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791301",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761502",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877047830",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980063210",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788401409",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010013303",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791306",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304073490",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816001",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816003",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462039030",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877057190",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851101",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010013309",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843102",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980063209",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851103",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843106",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462039090",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382044106",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788859702",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041901",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843103",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862078390",
      "ndc_label_name": "Esomeprazole Magnesium CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69618005614",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788843109",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816006",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791302",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069081410",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69618007342",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788859703",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761506",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70000003201",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70069081490",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851102",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843101",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377005513",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205070630",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69230032031",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788761509",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335967803",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420022630",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377005512",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851109",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335165801",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042002",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205070660",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791309",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189038130",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69230032032",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789035230",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816002",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335967801",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70000003202",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "76420022690",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816009",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189038160",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010013310",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041902",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788859706",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335971303",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377005511",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042001",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788859709",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041903",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335250503",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069081430",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420022660",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335201803",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425011102",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425011101",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042003",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009003310",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008008330",
      "ndc_label_name": "Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "38779690402",
      "ndc_label_name": "Essentra Wipes 9x9\" Sheet 70 %",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "38779690401",
      "ndc_label_name": "Essentra Wipes 9x9\" Sheet 70 %",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591074401",
      "ndc_label_name": "Estazolam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959097030",
      "ndc_label_name": "Estazolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862007301",
      "ndc_label_name": "Estazolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862006901",
      "ndc_label_name": "Estazolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954048010",
      "ndc_label_name": "Estazolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999031715",
      "ndc_label_name": "Estazolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907002801",
      "ndc_label_name": "Estazolam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862007001",
      "ndc_label_name": "Estazolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907002901",
      "ndc_label_name": "Estazolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440751630",
      "ndc_label_name": "Estazolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591074501",
      "ndc_label_name": "Estazolam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862007401",
      "ndc_label_name": "Estazolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954048110",
      "ndc_label_name": "Estazolam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378877035",
      "ndc_label_name": "Estradiol Cream 0.01 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993000210",
      "ndc_label_name": "Estradiol Cream 0.01 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922008506",
      "ndc_label_name": "Estradiol Cream 0.01 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802009735",
      "ndc_label_name": "Estradiol Cream 0.01 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090364500",
      "ndc_label_name": "Estradiol Cream 0.01 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335283101",
      "ndc_label_name": "Estradiol Cream 0.01 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093354143",
      "ndc_label_name": "Estradiol Cream 0.01 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090726600",
      "ndc_label_name": "Estradiol Cream 0.01 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629865401",
      "ndc_label_name": "Estradiol Cream 0.01 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781010444",
      "ndc_label_name": "Estradiol Cream 0.01 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090332700",
      "ndc_label_name": "Estradiol Cream 0.01 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162138902",
      "ndc_label_name": "Estradiol Cream 0.01 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291042642",
      "ndc_label_name": "Estradiol Cream 0.01 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629871301",
      "ndc_label_name": "Estradiol Cream 0.01 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090681100",
      "ndc_label_name": "Estradiol Cream 0.01 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115151866",
      "ndc_label_name": "Estradiol Cream 0.1 MG/GM Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378464426",
      "ndc_label_name": "Estradiol Patch Twice Weekly 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781712958",
      "ndc_label_name": "Estradiol Patch Twice Weekly 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378461926",
      "ndc_label_name": "Estradiol Patch Twice Weekly 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378461916",
      "ndc_label_name": "Estradiol Patch Twice Weekly 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710119101",
      "ndc_label_name": "Estradiol Patch Twice Weekly 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68968342501",
      "ndc_label_name": "Estradiol Patch Twice Weekly 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781712983",
      "ndc_label_name": "Estradiol Patch Twice Weekly 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378464416",
      "ndc_label_name": "Estradiol Patch Twice Weekly 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68968342508",
      "ndc_label_name": "Estradiol Patch Twice Weekly 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710119108",
      "ndc_label_name": "Estradiol Patch Twice Weekly 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378334999",
      "ndc_label_name": "Estradiol PATCH WEEKLY 0.025 MG/24HR TRANSDERMAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378334916",
      "ndc_label_name": "Estradiol PATCH WEEKLY 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781711958",
      "ndc_label_name": "Estradiol Patch Weekly 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781711954",
      "ndc_label_name": "Estradiol Patch Weekly 0.025 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658070201",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090549401",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788862603",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555089902",
      "ndc_label_name": "Estradiol TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090188200",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862033201",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008705",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008701",
      "ndc_label_name": "Estradiol TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789203",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429083301",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788862606",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090188201",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788733203",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919019830",
      "ndc_label_name": "Estradiol TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090549400",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090249000",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789206",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629880201",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788848101",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788848109",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788733206",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789201",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789048930",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788733209",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788789209",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788733201",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603027301",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788862601",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788848103",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788848106",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788862609",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954056410",
      "ndc_label_name": "Estradiol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555088604",
      "ndc_label_name": "Estradiol TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635902",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008801",
      "ndc_label_name": "Estradiol TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788710201",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658070301",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658070305",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862033305",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555088602",
      "ndc_label_name": "Estradiol TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090635900",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090745200",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063070690",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788710206",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063070630",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090194100",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118088603",
      "ndc_label_name": "Estradiol TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008805",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090684700",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090748002",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429083401",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788886001",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090748000",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187074130",
      "ndc_label_name": "Estradiol TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788710209",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090170400",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862033301",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187074190",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788705401",
      "ndc_label_name": "Estradiol TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090170402",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090748100",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788710203",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189018360",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090194102",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687087611",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788705406",
      "ndc_label_name": "Estradiol TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788886003",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788796103",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429083405",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954056520",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189018390",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788886006",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788705409",
      "ndc_label_name": "Estradiol TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189050260",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789029930",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788886009",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687087665",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954056510",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934054130",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603027402",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788705403",
      "ndc_label_name": "Estradiol TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603027401",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788796101",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789029990",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788796106",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788796109",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189050290",
      "ndc_label_name": "Estradiol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629880401",
      "ndc_label_name": "Estradiol Tablet 10 MCG Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651043908",
      "ndc_label_name": "Estradiol Tablet 10 MCG Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629880301",
      "ndc_label_name": "Estradiol Tablet 10 MCG Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603087418",
      "ndc_label_name": "Estradiol Tablet 10 MCG Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093322397",
      "ndc_label_name": "Estradiol TABLET 10 MCG Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093322308",
      "ndc_label_name": "Estradiol TABLET 10 MCG Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603087408",
      "ndc_label_name": "Estradiol Tablet 10 MCG Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462071182",
      "ndc_label_name": "Estradiol Tablet 10 MCG Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651043918",
      "ndc_label_name": "Estradiol Tablet 10 MCG Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462071171",
      "ndc_label_name": "Estradiol Tablet 10 MCG Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462071188",
      "ndc_label_name": "Estradiol Tablet 10 MCG Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462071176",
      "ndc_label_name": "Estradiol Tablet 10 MCG Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555088704",
      "ndc_label_name": "Estradiol TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658070405",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063071730",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090636302",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862033405",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555088702",
      "ndc_label_name": "Estradiol TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658070401",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862033401",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008901",
      "ndc_label_name": "Estradiol TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806008905",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063071790",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959032300",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429083505",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189050890",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959032330",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603027501",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090187600",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090636300",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090262400",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603027502",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934039330",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429083501",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954056620",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954056610",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189019890",
      "ndc_label_name": "Estradiol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135079601",
      "ndc_label_name": "Ethambutol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090233701",
      "ndc_label_name": "Ethambutol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180028001",
      "ndc_label_name": "Ethambutol HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806010101",
      "ndc_label_name": "Ethambutol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54879000101",
      "ndc_label_name": "Ethambutol HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084028011",
      "ndc_label_name": "Ethambutol HCl TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806010201",
      "ndc_label_name": "Ethambutol HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135079701",
      "ndc_label_name": "Ethambutol HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54879000201",
      "ndc_label_name": "Ethambutol HCl TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180028101",
      "ndc_label_name": "Ethambutol HCl TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090239900",
      "ndc_label_name": "Ethambutol HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084028001",
      "ndc_label_name": "Ethambutol HCl TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762225002",
      "ndc_label_name": "Ethosuximide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155053201",
      "ndc_label_name": "Ethosuximide CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806070801",
      "ndc_label_name": "Ethosuximide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748002501",
      "ndc_label_name": "Ethosuximide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380087806",
      "ndc_label_name": "Ethosuximide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806071101",
      "ndc_label_name": "Ethosuximide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452015220",
      "ndc_label_name": "Ethosuximide CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135079012",
      "ndc_label_name": "Ethosuximide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121067016",
      "ndc_label_name": "Ethosuximide SOLUTION 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762235006",
      "ndc_label_name": "Ethosuximide Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762235007",
      "ndc_label_name": "Ethosuximide Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "38779126708",
      "ndc_label_name": "Ethyl Oleate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452288501",
      "ndc_label_name": "Ethyl Oleate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779126701",
      "ndc_label_name": "Ethyl Oleate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991265301",
      "ndc_label_name": "Ethyl Oleate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452288503",
      "ndc_label_name": "Ethyl Oleate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452288601",
      "ndc_label_name": "Ethyl Oleate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552123808",
      "ndc_label_name": "Ethyl Oleate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452288502",
      "ndc_label_name": "Ethyl Oleate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991265303",
      "ndc_label_name": "Ethyl Oleate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51552123806",
      "ndc_label_name": "Ethyl Oleate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991265302",
      "ndc_label_name": "Ethyl Oleate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927354900",
      "ndc_label_name": "Ethyl Oleate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552123807",
      "ndc_label_name": "Ethyl Oleate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991265304",
      "ndc_label_name": "Ethyl Oleate Liquid",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00378730753",
      "ndc_label_name": "Ethynodiol Diac-Eth Estradiol TABLET 1-35 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378730785",
      "ndc_label_name": "Ethynodiol Diac-Eth Estradiol TABLET 1-35 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185067510",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440751928",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090396301",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440751921",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090179000",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185067501",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440751912",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085660",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999003800",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440751930",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059260",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799011101",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047160",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085630",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440751915",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178902",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178901",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063083460",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009290",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090396302",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002120706",
      "ndc_label_name": "Etodolac TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178905",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047102",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436004102",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047112",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085620",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858006",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672401801",
      "ndc_label_name": "Etodolac TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002120709",
      "ndc_label_name": "Etodolac TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090405300",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047120",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629880501",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047115",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075253",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884609",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429031101",
      "ndc_label_name": "Etodolac TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135091060",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047114",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047125",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267009528",
      "ndc_label_name": "Etodolac TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047128",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075260",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69306002040",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505004101",
      "ndc_label_name": "Etodolac TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267009500",
      "ndc_label_name": "Etodolac TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059230",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002120702",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731503",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047130",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075280",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012602",
      "ndc_label_name": "Etodolac TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760055220",
      "ndc_label_name": "Etodolac TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884606",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760055214",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002120703",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731506",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187079620",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075283",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012604",
      "ndc_label_name": "Etodolac TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009260",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012601",
      "ndc_label_name": "Etodolac TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073620",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731501",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867302",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267009530",
      "ndc_label_name": "Etodolac TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090396305",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012607",
      "ndc_label_name": "Etodolac TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025160",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060203",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267009556",
      "ndc_label_name": "Etodolac TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867303",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867309",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267009590",
      "ndc_label_name": "Etodolac TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047190",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060201",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267009540",
      "ndc_label_name": "Etodolac TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060206",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267009591",
      "ndc_label_name": "Etodolac TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884603",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080430",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731502",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002120701",
      "ndc_label_name": "Etodolac TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060204",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884602",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080460",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867301",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085953",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238134201",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012606",
      "ndc_label_name": "Etodolac TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760055260",
      "ndc_label_name": "Etodolac TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080453",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012603",
      "ndc_label_name": "Etodolac TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055101",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884601",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789053828",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012605",
      "ndc_label_name": "Etodolac TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012608",
      "ndc_label_name": "Etodolac TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009230",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085960",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060202",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080480",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079480",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085980",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060205",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081680",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025130",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060208",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385011801",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081653",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731509",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081660",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867306",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085930",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060207",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014002",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008007360",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019002",
      "ndc_label_name": "Etodolac Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700075730",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090673905",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185068701",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063067130",
      "ndc_label_name": "Etodolac TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053002",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053090",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074956",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752030",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057430",
      "ndc_label_name": "Etodolac TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053030",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799011201",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053014",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788730002",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788730001",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090213305",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074918",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071039330",
      "ndc_label_name": "Etodolac TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053045",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002137503",
      "ndc_label_name": "Etodolac TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002137506",
      "ndc_label_name": "Etodolac TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205046760",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053060",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090397405",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074953",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788730003",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429031201",
      "ndc_label_name": "Etodolac TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057460",
      "ndc_label_name": "Etodolac TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505010201",
      "ndc_label_name": "Etodolac TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335039903",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385011901",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053028",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090148905",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079553",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788730008",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788730006",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403601",
      "ndc_label_name": "Etodolac TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919085830",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238134301",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788730009",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053020",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077953",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135091160",
      "ndc_label_name": "Etodolac Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993060536",
      "ndc_label_name": "Etonogestrel-Ethinyl Estradiol Ring 0.12-0.015 MG/24HR Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993060581",
      "ndc_label_name": "Etonogestrel-Ethinyl Estradiol Ring 0.12-0.015 MG/24HR Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093767902",
      "ndc_label_name": "Etonogestrel-Ethinyl Estradiol Ring 0.12-0.015 MG/24HR Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714002903",
      "ndc_label_name": "Etonogestrel-Ethinyl Estradiol Ring 0.12-0.015 MG/24HR Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291047803",
      "ndc_label_name": "Etonogestrel-Ethinyl Estradiol Ring 0.12-0.015 MG/24HR Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093767901",
      "ndc_label_name": "Etonogestrel-Ethinyl Estradiol Ring 0.12-0.015 MG/24HR Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090595900",
      "ndc_label_name": "Etonogestrel-Ethinyl Estradiol Ring 0.12-0.015 MG/24HR Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714002901",
      "ndc_label_name": "Etonogestrel-Ethinyl Estradiol Ring 0.12-0.015 MG/24HR Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378326632",
      "ndc_label_name": "Etoposide Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378326694",
      "ndc_label_name": "Etoposide CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452025422",
      "ndc_label_name": "Etravirine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315028520",
      "ndc_label_name": "Etravirine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10147057001",
      "ndc_label_name": "Etravirine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291047312",
      "ndc_label_name": "Etravirine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219172107",
      "ndc_label_name": "Etravirine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315028606",
      "ndc_label_name": "Etravirine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219172206",
      "ndc_label_name": "Etravirine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10147057101",
      "ndc_label_name": "Etravirine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291047460",
      "ndc_label_name": "Etravirine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452025517",
      "ndc_label_name": "Etravirine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55724021111",
      "ndc_label_name": "Eucrisa Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55724021123",
      "ndc_label_name": "Eucrisa Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55724021121",
      "ndc_label_name": "Eucrisa Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00003364111",
      "ndc_label_name": "Evotaz TABLET 300-150 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090172400",
      "ndc_label_name": "Evotaz Tablet 300-150 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078056961",
      "ndc_label_name": "Extavia Kit 0.3 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078056999",
      "ndc_label_name": "Extavia Kit 0.3 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078056912",
      "ndc_label_name": "Extavia Kit 0.3 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591371330",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781569005",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591371305",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591371319",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904710310",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714081303",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904710304",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714081302",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781569031",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722062830",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135078730",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781569092",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135078790",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651005205",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714081301",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729043316",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729043315",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722062890",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090663100",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135078705",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722062805",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462022690",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729043310",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090768900",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090342201",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090663000",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228037905",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090271700",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090308701",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788829709",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090340201",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429098230",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651005290",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090663001",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228037990",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090308700",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090340200",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335112702",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090365701",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505294509",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429098205",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877049030",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462022630",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090709900",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090342200",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382077305",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268029811",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877049005",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505294505",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238115405",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804021130",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733901",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090365700",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205027730",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51660020005",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462022605",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238115403",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769000",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51660020030",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238115409",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733800",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268029812",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651005230",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804006430",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011830",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51660020090",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877049090",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687037311",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733900",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687037321",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205014530",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382077316",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769001",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009002405",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228037930",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429098290",
      "ndc_label_name": "Ezetimibe TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382077306",
      "ndc_label_name": "Ezetimibe Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862046530",
      "ndc_label_name": "Famciclovir TABLET 125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291041430",
      "ndc_label_name": "Famciclovir Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429035930",
      "ndc_label_name": "Famciclovir Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440750010",
      "ndc_label_name": "Famciclovir Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093811756",
      "ndc_label_name": "Famciclovir TABLET 125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714061401",
      "ndc_label_name": "Famciclovir Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440750002",
      "ndc_label_name": "Famciclovir Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980034903",
      "ndc_label_name": "Famciclovir Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505324503",
      "ndc_label_name": "Famciclovir Tablet 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070630",
      "ndc_label_name": "Famciclovir TABLET 125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342002407",
      "ndc_label_name": "Famciclovir TABLET 125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093811856",
      "ndc_label_name": "Famciclovir TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714061501",
      "ndc_label_name": "Famciclovir Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291041530",
      "ndc_label_name": "Famciclovir Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440750121",
      "ndc_label_name": "Famciclovir Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505324603",
      "ndc_label_name": "Famciclovir TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862046630",
      "ndc_label_name": "Famciclovir TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187091921",
      "ndc_label_name": "Famciclovir Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070730",
      "ndc_label_name": "Famciclovir TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980035003",
      "ndc_label_name": "Famciclovir Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342002507",
      "ndc_label_name": "Famciclovir TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440750160",
      "ndc_label_name": "Famciclovir Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429036030",
      "ndc_label_name": "Famciclovir Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342002607",
      "ndc_label_name": "Famciclovir TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070830",
      "ndc_label_name": "Famciclovir TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959094621",
      "ndc_label_name": "Famciclovir Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333700",
      "ndc_label_name": "Famciclovir Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306600",
      "ndc_label_name": "Famciclovir Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093811956",
      "ndc_label_name": "Famciclovir TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092021",
      "ndc_label_name": "Famciclovir Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959094604",
      "ndc_label_name": "Famciclovir Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291041630",
      "ndc_label_name": "Famciclovir Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440750202",
      "ndc_label_name": "Famciclovir Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505324703",
      "ndc_label_name": "Famciclovir TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099830",
      "ndc_label_name": "Famciclovir Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289016803",
      "ndc_label_name": "Famciclovir TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714061601",
      "ndc_label_name": "Famciclovir Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980035103",
      "ndc_label_name": "Famciclovir Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099821",
      "ndc_label_name": "Famciclovir Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429036130",
      "ndc_label_name": "Famciclovir Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205060921",
      "ndc_label_name": "Famciclovir Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862046730",
      "ndc_label_name": "Famciclovir TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338519741",
      "ndc_label_name": "Famotidine Premixed SOLUTION 20-0.9 MG/50ML-% Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323073803",
      "ndc_label_name": "Famotidine Solution 40 MG/4ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457044843",
      "ndc_label_name": "Famotidine SOLUTION 40 MG/4ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602301",
      "ndc_label_name": "Famotidine Solution 40 MG/4ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323073809",
      "ndc_label_name": "Famotidine SOLUTION 40 MG/4ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602310",
      "ndc_label_name": "Famotidine Solution 40 MG/4ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641602325",
      "ndc_label_name": "Famotidine Solution 40 MG/4ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457044800",
      "ndc_label_name": "Famotidine SOLUTION 40 MG/4ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832604510",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832604515",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382044405",
      "ndc_label_name": "Famotidine SUSPENSION RECONSTITUTED 40 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714024401",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722006331",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651070150",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377011311",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832604550",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407045250",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571043345",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162259902",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241024949",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238209004",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603017101",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180015001",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386050011",
      "ndc_label_name": "Famotidine SUSPENSION RECONSTITUTED 40 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954031610",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80005011916",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219209004",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205023384",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877077589",
      "ndc_label_name": "Famotidine Suspension Reconstituted 40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752630",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722001801",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440652630",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172572970",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440652685",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440652601",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722001810",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172572960",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722001805",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959011660",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752660",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291028210",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090388801",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090388800",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069660",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440652600",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063053330",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012030",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069630",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069693",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407068401",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268030411",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069695",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440652660",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090143200",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118093706",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069690",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090719600",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760007060",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407068410",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012001",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440652681",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002066730",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919023630",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090143201",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268030415",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980062450",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760073607",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111012010",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407068418",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760007007",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332000231",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090679000",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118093703",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001039800",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629278202",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760093760",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760032760",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788685908",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629278205",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090679001",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760073660",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788685901",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877084301",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135080890",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760084360",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828501",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001039803",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090691600",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442012201",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792206",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792208",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187090830",
      "ndc_label_name": "Famotidine TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760093707",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873304",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828508",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959011630",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332000271",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792209",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851803",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629278201",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442012210",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205014605",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873303",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118093709",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187090890",
      "ndc_label_name": "Famotidine TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828503",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851806",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629278204",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919023660",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098155",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205014691",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429072101",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629201401",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828506",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710168405",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629278207",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862086099",
      "ndc_label_name": "Famotidine TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098178",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098167",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760032707",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629201501",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851809",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205025730",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862086001",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792203",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205063430",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335961501",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760084307",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629278203",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173701",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710168400",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877088905",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629278206",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789034530",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756005211",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332000291",
      "ndc_label_name": "Famotidine TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980062401",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098190",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189020730",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788685903",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980062410",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792201",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205014630",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788685906",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877084305",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710168401",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789045330",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873306",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877088901",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756005212",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865021518",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873309",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788685909",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205063490",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804022830",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367040110",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828509",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173700",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098100",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606051004",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851804",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606051002",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205025790",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865021505",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189020790",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098160",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205014699",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098172",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789042790",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865021501",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098120",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098130",
      "ndc_label_name": "Famotidine Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310183085",
      "ndc_label_name": "Fasenra Pen Solution Auto-Injector 30 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310183030",
      "ndc_label_name": "Fasenra Pen Solution Auto-Injector 30 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310173030",
      "ndc_label_name": "Fasenra Solution Prefilled Syringe 30 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090112500",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603358321",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013405",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999057210",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013490",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013410",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752490",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090587000",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237011001",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603358328",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008905",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090112400",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442043305",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155005001",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090720600",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629201601",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092230",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013401",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135064890",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242100",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629219201",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489037001",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657068750",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117003001",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162116001",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657068701",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092290",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008901",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462023501",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092260",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067599",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092200",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117003002",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304043701",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367026601",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629219101",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162116005",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174405",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092255",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092272",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013205",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752290",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013201",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603358121",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002801",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603358128",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442043105",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013210",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367026401",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629201701",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657068550",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155004801",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092000",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013290",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135064690",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489036801",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092030",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067301",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629930101",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008701",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092055",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008705",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002802",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237010801",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162115801",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162115805",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092072",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067399",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629219401",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657068501",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174205",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304043501",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092090",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629219301",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462023301",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092060",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162256801",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155004901",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304043601",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067499",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752390",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013301",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603358221",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013390",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657068601",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462023401",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999082110",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008805",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603358228",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013310",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407008801",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489036901",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657068650",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092172",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002901",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629201801",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668013305",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237010901",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117002902",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162115901",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135064790",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092130",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367026501",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092155",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442043205",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092100",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092190",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092160",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629219501",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162115905",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629219601",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174305",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067401",
      "ndc_label_name": "Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722059690",
      "ndc_label_name": "Fenofibrate TABLET 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090285700",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904748004",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378306677",
      "ndc_label_name": "Fenofibrate TABLET 145 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378306605",
      "ndc_label_name": "Fenofibrate TABLET 145 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904716161",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904716104",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547043109",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291004590",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180038909",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090724200",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904748061",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655001052",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304044905",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090693400",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079060820",
      "ndc_label_name": "Fenofibrate TABLET 145 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304044990",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788810601",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407000690",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090304400",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382027016",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180036109",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332036190",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020590",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862076990",
      "ndc_label_name": "Fenofibrate TABLET 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788793206",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687062901",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090403100",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400601",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180036102",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180038902",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687062921",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400606",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788810609",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757903",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332036171",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757901",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757909",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400603",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788793203",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757906",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788793209",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788810603",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788793201",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400609",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788810606",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73190001690",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315028805",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097045805",
      "ndc_label_name": "Fenofibrate TABLET 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315028809",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009006090",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002783",
      "ndc_label_name": "Fenofibrate Tablet 145 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858066045",
      "ndc_label_name": "Fenofibrate TABLET 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291042790",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090127500",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115552202",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378710177",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356091630",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904712804",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241011703",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353000119",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385093605",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090515801",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115552210",
      "ndc_label_name": "Fenofibrate TABLET 160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35561034413",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291029090",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904753904",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241011705",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353089819",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385093690",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090697300",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35561034411",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291029030",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090337300",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254601",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090127501",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268031311",
      "ndc_label_name": "Fenofibrate TABLET 160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090337301",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090697301",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598091005",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291042750",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090585400",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090792700",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254600",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700087630",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090697400",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407009490",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090720800",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598091090",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687086411",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268031315",
      "ndc_label_name": "Fenofibrate TABLET 160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090585401",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083130",
      "ndc_label_name": "Fenofibrate TABLET 160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090792601",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332053991",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090720801",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629109904",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687086421",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135083890",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090792600",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187076090",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118552209",
      "ndc_label_name": "Fenofibrate TABLET 160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781603",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090720900",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019030",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760041130",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332055591",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651057690",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304090105",
      "ndc_label_name": "Fenofibrate TABLET 160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760066030",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756021551",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219552209",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019090",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332055590",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180023209",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219552205",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757803",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332053990",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934063830",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687066611",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017290",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757801",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766206",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187076030",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757806",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084032821",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094930",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687066621",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757809",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886102",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781609",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084032811",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367025409",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766209",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886101",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760031830",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603084101",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094960",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315029009",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766201",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008007230",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367025405",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756021590",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304090190",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335074101",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094972",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002630",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766203",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162217009",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629109901",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162215209",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934022330",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629109903",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094955",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315029005",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094978",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094990",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335074102",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017230",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603084102",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789041030",
      "ndc_label_name": "Fenofibrate Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378306577",
      "ndc_label_name": "Fenofibrate TABLET 48 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268033811",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547043009",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305600",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722059590",
      "ndc_label_name": "Fenofibrate TABLET 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268033812",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097045905",
      "ndc_label_name": "Fenofibrate TABLET 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090532700",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090269200",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020490",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090388700",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407000590",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187094090",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061811",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315028709",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180038809",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332036071",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061821",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079059920",
      "ndc_label_name": "Fenofibrate TABLET 48 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205005090",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304044890",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304044805",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332036090",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73190001590",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382026916",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862076890",
      "ndc_label_name": "Fenofibrate TABLET 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180036009",
      "ndc_label_name": "Fenofibrate Tablet 48 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090247600",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205036690",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858045445",
      "ndc_label_name": "Fenofibrate TABLET 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115551110",
      "ndc_label_name": "Fenofibrate TABLET 54 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35561034311",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378710077",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241011603",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268031211",
      "ndc_label_name": "Fenofibrate TABLET 54 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325500",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291028990",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687065511",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385093590",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598090990",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757200",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090524401",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687085311",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407009390",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332053890",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687065521",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090622700",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090524400",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332055490",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180023109",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084082725",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687085321",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315028909",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756021451",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090622701",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651057590",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757201",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304090090",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268031215",
      "ndc_label_name": "Fenofibrate TABLET 54 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629110101",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219551109",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084082795",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135083790",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367025709",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756021490",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205066630",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603084001",
      "ndc_label_name": "Fenofibrate Tablet 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065805",
      "ndc_label_name": "FentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742055605",
      "ndc_label_name": "fentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406910076",
      "ndc_label_name": "FentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505700900",
      "ndc_label_name": "fentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378912416",
      "ndc_label_name": "FentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781042847",
      "ndc_label_name": "FentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781042811",
      "ndc_label_name": "FentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378912498",
      "ndc_label_name": "FentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406900076",
      "ndc_label_name": "FentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505700902",
      "ndc_label_name": "fentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999083401",
      "ndc_label_name": "fentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071137505",
      "ndc_label_name": "FentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742055601",
      "ndc_label_name": "fentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505708400",
      "ndc_label_name": "fentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505708402",
      "ndc_label_name": "fentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629416701",
      "ndc_label_name": "FentaNYL Patch 72 Hour 100 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781042347",
      "ndc_label_name": "FentaNYL Patch 72 Hour 12 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505701000",
      "ndc_label_name": "fentaNYL Patch 72 Hour 12 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505708000",
      "ndc_label_name": "fentaNYL Patch 72 Hour 12 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378911916",
      "ndc_label_name": "FentaNYL Patch 72 Hour 12 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406911276",
      "ndc_label_name": "fentaNYL Patch 72 Hour 12 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378911998",
      "ndc_label_name": "FentaNYL Patch 72 Hour 12 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700074905",
      "ndc_label_name": "fentaNYL Patch 72 Hour 12 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742054905",
      "ndc_label_name": "fentaNYL Patch 72 Hour 12 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505701002",
      "ndc_label_name": "fentaNYL Patch 72 Hour 12 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406901276",
      "ndc_label_name": "fentaNYL Patch 72 Hour 12 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097205",
      "ndc_label_name": "fentaNYL Patch 72 Hour 12 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505708002",
      "ndc_label_name": "fentaNYL Patch 72 Hour 12 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742054901",
      "ndc_label_name": "fentaNYL Patch 72 Hour 12 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629417801",
      "ndc_label_name": "FentaNYL Patch 72 Hour 12 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781042447",
      "ndc_label_name": "FentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959058505",
      "ndc_label_name": "FentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505708102",
      "ndc_label_name": "fentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378912116",
      "ndc_label_name": "FentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378912198",
      "ndc_label_name": "FentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742055001",
      "ndc_label_name": "fentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335068303",
      "ndc_label_name": "FentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406902576",
      "ndc_label_name": "FentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999083101",
      "ndc_label_name": "fentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060205",
      "ndc_label_name": "FentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059705",
      "ndc_label_name": "fentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629416601",
      "ndc_label_name": "FentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742055005",
      "ndc_label_name": "fentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406912576",
      "ndc_label_name": "FentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700075305",
      "ndc_label_name": "FentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071137305",
      "ndc_label_name": "FentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505708100",
      "ndc_label_name": "fentaNYL Patch 72 Hour 25 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406915076",
      "ndc_label_name": "FentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406905076",
      "ndc_label_name": "fentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378912216",
      "ndc_label_name": "FentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378912298",
      "ndc_label_name": "FentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060305",
      "ndc_label_name": "FentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505708200",
      "ndc_label_name": "fentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505708202",
      "ndc_label_name": "fentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742055205",
      "ndc_label_name": "fentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781042647",
      "ndc_label_name": "FentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071137405",
      "ndc_label_name": "FentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999083201",
      "ndc_label_name": "fentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742055201",
      "ndc_label_name": "fentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959058605",
      "ndc_label_name": "fentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700074805",
      "ndc_label_name": "fentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629416801",
      "ndc_label_name": "FentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097305",
      "ndc_label_name": "fentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629549201",
      "ndc_label_name": "fentaNYL Patch 72 Hour 50 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378912398",
      "ndc_label_name": "FentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406917576",
      "ndc_label_name": "FentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505700802",
      "ndc_label_name": "fentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742055405",
      "ndc_label_name": "fentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081105",
      "ndc_label_name": "FentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378912316",
      "ndc_label_name": "FentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505708300",
      "ndc_label_name": "fentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999083301",
      "ndc_label_name": "fentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406907576",
      "ndc_label_name": "fentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959016005",
      "ndc_label_name": "fentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629416501",
      "ndc_label_name": "FentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505700800",
      "ndc_label_name": "fentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781042747",
      "ndc_label_name": "FentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742055401",
      "ndc_label_name": "fentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999083305",
      "ndc_label_name": "fentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505708302",
      "ndc_label_name": "fentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629498203",
      "ndc_label_name": "fentaNYL Patch 72 Hour 75 MCG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00087074002",
      "ndc_label_name": "Fer-In-Sol Solution 75 (15 Fe) MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00087074026",
      "ndc_label_name": "Fer-In-Sol Solution 75 (15 Fe) MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904640360",
      "ndc_label_name": "Ferate TABLET 240 (27 Fe) MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51991018142",
      "ndc_label_name": "Ferrocite TABLET 324 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "20555001900",
      "ndc_label_name": "Ferrous Gluconate Tablet 324 (37.5 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629064501",
      "ndc_label_name": "Ferrous Gluconate TABLET 324 (37.5 Fe) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090026900",
      "ndc_label_name": "Ferrous Gluconate Tablet 324 (38 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090026902",
      "ndc_label_name": "Ferrous Gluconate Tablet 324 (38 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00574050801",
      "ndc_label_name": "Ferrous Gluconate Tablet 324 (38 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090026903",
      "ndc_label_name": "Ferrous Gluconate Tablet 324 (38 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00574050811",
      "ndc_label_name": "Ferrous Gluconate Tablet 324 (38 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00574050810",
      "ndc_label_name": "Ferrous Gluconate Tablet 324 (38 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69367016504",
      "ndc_label_name": "Ferrous Gluconate Tablet 324 (38 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69375000910",
      "ndc_label_name": "Ferrous Gluconate Tablet 324 (38 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69367016507",
      "ndc_label_name": "Ferrous Gluconate Tablet 324 (38 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50383077816",
      "ndc_label_name": "Ferrous Sulfate Elixir 220 (44 Fe) MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536115516",
      "ndc_label_name": "Ferrous Sulfate Liquid 220 (44 Fe) MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45861007001",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 324 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57237036501",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 324 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00574060801",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 324 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00574060810",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 324 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72789043601",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 324 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72789032201",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 324 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57237036510",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 324 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00574060811",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 324 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57237036610",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 325 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00245010811",
      "ndc_label_name": "Ferrous Sulfate TABLET DELAYED RELEASE 325 (65 Fe) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00245010810",
      "ndc_label_name": "Ferrous Sulfate TABLET DELAYED RELEASE 325 (65 Fe) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00245010889",
      "ndc_label_name": "Ferrous Sulfate TABLET DELAYED RELEASE 325 (65 Fe) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904216680",
      "ndc_label_name": "Ferrous Sulfate TABLET DELAYED RELEASE 325 (65 Fe) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "85633001100",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 325 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00245010801",
      "ndc_label_name": "Ferrous Sulfate TABLET DELAYED RELEASE 325 (65 Fe) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "85633001160",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 325 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "85633001136",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 325 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135016101",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 325 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69367016620",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 325 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353041765",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 325 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69367016604",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 325 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57237036601",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 325 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "85633001101",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 325 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69367016607",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 325 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "85633001105",
      "ndc_label_name": "Ferrous Sulfate Tablet Delayed Release 325 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51672211402",
      "ndc_label_name": "FeverAll Infants SUPPOSITORY 80 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672211400",
      "ndc_label_name": "FeverAll Infants SUPPOSITORY 80 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672211404",
      "ndc_label_name": "FeverAll Infants SUPPOSITORY 80 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598082314",
      "ndc_label_name": "Fexofenadine-Pseudoephed ER Tablet Extended Release 12 Hour 60-120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51660003731",
      "ndc_label_name": "Fexofenadine-Pseudoephed ER Tablet Extended Release 12 Hour 60-120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "55111044714",
      "ndc_label_name": "Fexofenadine-Pseudoephed ER Tablet Extended Release 12 Hour 60-120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43598082335",
      "ndc_label_name": "Fexofenadine-Pseudoephed ER Tablet Extended Release 12 Hour 60-120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43598082331",
      "ndc_label_name": "Fexofenadine-Pseudoephed ER Tablet Extended Release 12 Hour 60-120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536139426",
      "ndc_label_name": "Fexofenadine-Pseudoephed ER Tablet Extended Release 24 Hour 180-240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43598089235",
      "ndc_label_name": "Fexofenadine-Pseudoephed ER Tablet Extended Release 24 Hour 180-240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "55111055735",
      "ndc_label_name": "Fexofenadine-Pseudoephed ER Tablet Extended Release 24 Hour 180-240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917009986",
      "ndc_label_name": "Fiber (Corn Dextrin) POWDER ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50024043001",
      "ndc_label_name": "FiberCon Tablet 625 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50024043002",
      "ndc_label_name": "FiberCon Tablet 625 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83490041058",
      "ndc_label_name": "Filter Air PP",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025730",
      "ndc_label_name": "Fingolimod HCl Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756006483",
      "ndc_label_name": "Fingolimod HCl Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505433203",
      "ndc_label_name": "Fingolimod HCl Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729034210",
      "ndc_label_name": "Fingolimod HCl Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480782056",
      "ndc_label_name": "Fingolimod HCl Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378452593",
      "ndc_label_name": "Fingolimod HCl Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722088930",
      "ndc_label_name": "Fingolimod HCl Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291004830",
      "ndc_label_name": "Fingolimod HCl Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862095230",
      "ndc_label_name": "Fingolimod HCl Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009014330",
      "ndc_label_name": "Fingolimod HCl Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877047630",
      "ndc_label_name": "Fingolimod HCl Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598028530",
      "ndc_label_name": "Fingolimod HCl Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382091206",
      "ndc_label_name": "Fingolimod HCl Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980044903",
      "ndc_label_name": "Fingolimod HCl Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462016630",
      "ndc_label_name": "Fingolimod HCl Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904731813",
      "ndc_label_name": "Fish Oil Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904750313",
      "ndc_label_name": "Fish Oil Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333030725",
      "ndc_label_name": "Fish Oil CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333030710",
      "ndc_label_name": "Fish Oil CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904560413",
      "ndc_label_name": "Fish Oil Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40093010326",
      "ndc_label_name": "Fish Oil Capsule Delayed Release 1200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768027664",
      "ndc_label_name": "Fish Oil Extra Strength CAPSULE 1200 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00574011501",
      "ndc_label_name": "FlavoxATE HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658072001",
      "ndc_label_name": "FlavoxATE HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032415",
      "ndc_label_name": "FlavoxATE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032411",
      "ndc_label_name": "FlavoxATE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005801",
      "ndc_label_name": "FlavoxATE HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001121",
      "ndc_label_name": "Flecainide Acetate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032111",
      "ndc_label_name": "Flecainide Acetate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806081801",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038301",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001125",
      "ndc_label_name": "Flecainide Acetate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001120",
      "ndc_label_name": "Flecainide Acetate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090296800",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407001960",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440754360",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746064201",
      "ndc_label_name": "Flecainide Acetate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090223300",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385014601",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090731600",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407001901",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038393",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038360",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032115",
      "ndc_label_name": "Flecainide Acetate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237006401",
      "ndc_label_name": "Flecainide Acetate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629194501",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335257703",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629798203",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135066160",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862062201",
      "ndc_label_name": "Flecainide Acetate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559038101",
      "ndc_label_name": "Flecainide Acetate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162176101",
      "ndc_label_name": "Flecainide Acetate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001225",
      "ndc_label_name": "Flecainide Acetate TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237006501",
      "ndc_label_name": "Flecainide Acetate TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440754460",
      "ndc_label_name": "Flecainide Acetate Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806081901",
      "ndc_label_name": "Flecainide Acetate Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001221",
      "ndc_label_name": "Flecainide Acetate TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559038201",
      "ndc_label_name": "Flecainide Acetate TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135066260",
      "ndc_label_name": "Flecainide Acetate Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746064301",
      "ndc_label_name": "Flecainide Acetate TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407002001",
      "ndc_label_name": "Flecainide Acetate Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385014701",
      "ndc_label_name": "Flecainide Acetate Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038401",
      "ndc_label_name": "Flecainide Acetate Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862062301",
      "ndc_label_name": "Flecainide Acetate TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038460",
      "ndc_label_name": "Flecainide Acetate Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629198101",
      "ndc_label_name": "Flecainide Acetate Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162176201",
      "ndc_label_name": "Flecainide Acetate Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038493",
      "ndc_label_name": "Flecainide Acetate Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001020",
      "ndc_label_name": "Flecainide Acetate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090113200",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407001801",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237006301",
      "ndc_label_name": "Flecainide Acetate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090530600",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032011",
      "ndc_label_name": "Flecainide Acetate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001025",
      "ndc_label_name": "Flecainide Acetate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001021",
      "ndc_label_name": "Flecainide Acetate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440754260",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746064101",
      "ndc_label_name": "Flecainide Acetate TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135066060",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629918401",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090603500",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804015530",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032015",
      "ndc_label_name": "Flecainide Acetate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806081701",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629194601",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038560",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385014501",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090681000",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162176001",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559038001",
      "ndc_label_name": "Flecainide Acetate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629797902",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038501",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038593",
      "ndc_label_name": "Flecainide Acetate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862062101",
      "ndc_label_name": "Flecainide Acetate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00132011946",
      "ndc_label_name": "Fleet Enema ENEMA 7-19 GM/118ML Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00132020220",
      "ndc_label_name": "Fleet Pediatric Enema 3.5-9.5 GM/59ML Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113009691",
      "ndc_label_name": "Flu/Severe Cold & Cough Day Packet 20-10-650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800009691",
      "ndc_label_name": "Flu/Severe Cold & Cough Day Packet 20-10-650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800055291",
      "ndc_label_name": "Flu/Severe Cold Daytime PACKET 10-650 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70461012103",
      "ndc_label_name": "Fluad Quadrivalent Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70461012203",
      "ndc_label_name": "Fluad Quadrivalent Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70461012104",
      "ndc_label_name": "Fluad Quadrivalent Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70461012204",
      "ndc_label_name": "Fluad Quadrivalent Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70461012304",
      "ndc_label_name": "Fluad Quadrivalent Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70461012303",
      "ndc_label_name": "Fluad Quadrivalent Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160090941",
      "ndc_label_name": "Fluarix Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160089041",
      "ndc_label_name": "Fluarix Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160088741",
      "ndc_label_name": "Fluarix Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160089052",
      "ndc_label_name": "Fluarix Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160088752",
      "ndc_label_name": "Fluarix Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160090952",
      "ndc_label_name": "Fluarix Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281072188",
      "ndc_label_name": "Flublok Quadrivalent Solution Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281072110",
      "ndc_label_name": "Flublok Quadrivalent Solution Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281072210",
      "ndc_label_name": "Flublok Quadrivalent Solution Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281072388",
      "ndc_label_name": "Flublok Quadrivalent Solution Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281072310",
      "ndc_label_name": "Flublok Quadrivalent Solution Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49281072288",
      "ndc_label_name": "Flublok Quadrivalent Solution Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70461032103",
      "ndc_label_name": "Flucelvax Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70461032203",
      "ndc_label_name": "Flucelvax Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70461032204",
      "ndc_label_name": "Flucelvax Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70461032304",
      "ndc_label_name": "Flucelvax Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70461032104",
      "ndc_label_name": "Flucelvax Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70461032303",
      "ndc_label_name": "Flucelvax Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714069501",
      "ndc_label_name": "Fluconazole SUSPENSION RECONSTITUTED 10 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014935",
      "ndc_label_name": "Fluconazole SUSPENSION RECONSTITUTED 10 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762502901",
      "ndc_label_name": "Fluconazole SUSPENSION RECONSTITUTED 10 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714069601",
      "ndc_label_name": "Fluconazole SUSPENSION RECONSTITUTED 40 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436022748",
      "ndc_label_name": "Fluconazole Suspension Reconstituted 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762503001",
      "ndc_label_name": "Fluconazole SUSPENSION RECONSTITUTED 40 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237015035",
      "ndc_label_name": "Fluconazole SUSPENSION RECONSTITUTED 40 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135013130",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268033715",
      "ndc_label_name": "Fluconazole TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407042530",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904650006",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999076502",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904650061",
      "ndc_label_name": "Fluconazole TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319400",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714069101",
      "ndc_label_name": "Fluconazole TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335055702",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407030030",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672406506",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268033711",
      "ndc_label_name": "Fluconazole TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919041930",
      "ndc_label_name": "Fluconazole TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714069102",
      "ndc_label_name": "Fluconazole TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118501603",
      "ndc_label_name": "Fluconazole TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090673300",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335055704",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205057310",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67405060203",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111014430",
      "ndc_label_name": "Fluconazole TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335055707",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063064510",
      "ndc_label_name": "Fluconazole TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559099130",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407030001",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084072811",
      "ndc_label_name": "Fluconazole TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335055705",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710113803",
      "ndc_label_name": "Fluconazole TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710113801",
      "ndc_label_name": "Fluconazole TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335055701",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407042501",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205009403",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343008601",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335055706",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804021803",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771039730",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065003",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111014401",
      "ndc_label_name": "Fluconazole TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762501601",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237000430",
      "ndc_label_name": "Fluconazole TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335055703",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919041910",
      "ndc_label_name": "Fluconazole TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629913401",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629194701",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084072801",
      "ndc_label_name": "Fluconazole TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001025204",
      "ndc_label_name": "Fluconazole TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189014010",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462010230",
      "ndc_label_name": "Fluconazole TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205009401",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065010",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771039701",
      "ndc_label_name": "Fluconazole Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063064202",
      "ndc_label_name": "Fluconazole TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714069211",
      "ndc_label_name": "Fluconazole TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090442500",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086900",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714069210",
      "ndc_label_name": "Fluconazole TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086903",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086902",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187058402",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086901",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576400",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090442501",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090219503",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090684201",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090219500",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090219501",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187058403",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090219502",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407030112",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343008711",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090442503",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959079901",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090442502",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576403",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001025344",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959079902",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407042612",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343008722",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576401",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111014571",
      "ndc_label_name": "Fluconazole TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576402",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090684200",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788729308",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959079912",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760011301",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700052101",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090684202",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187058404",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111014512",
      "ndc_label_name": "Fluconazole TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090684203",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205056303",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237000511",
      "ndc_label_name": "Fluconazole TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187009601",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700091601",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002119801",
      "ndc_label_name": "Fluconazole TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629194801",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028201",
      "ndc_label_name": "Fluconazole TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655043586",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760080301",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267130701",
      "ndc_label_name": "Fluconazole TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404801",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700094501",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760095001",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629897101",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559099212",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762501701",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135013277",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001025317",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788729301",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919033301",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187009602",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462011940",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462011944",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760080401",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788729302",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205008102",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788801",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187058401",
      "ndc_label_name": "Fluconazole TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795901",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205008104",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795902",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187009604",
      "ndc_label_name": "Fluconazole TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934050186",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079601",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934078386",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629798601",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335126801",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205056301",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795908",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267130801",
      "ndc_label_name": "Fluconazole TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189014901",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335126802",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788893808",
      "ndc_label_name": "Fluconazole TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67405060301",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420016401",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205056304",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710113908",
      "ndc_label_name": "Fluconazole TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788802",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079602",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189014301",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020902",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710113907",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020979",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788808",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034201",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205056302",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771039813",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205008101",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420058701",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789009602",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771039811",
      "ndc_label_name": "Fluconazole Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440753204",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675103",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959074502",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440753220",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675100",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090094703",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090094701",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904650106",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904650161",
      "ndc_label_name": "Fluconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111014630",
      "ndc_label_name": "Fluconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237000630",
      "ndc_label_name": "Fluconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407030201",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343008801",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319601",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675101",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407042730",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714069301",
      "ndc_label_name": "Fluconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118501803",
      "ndc_label_name": "Fluconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028330",
      "ndc_label_name": "Fluconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919038003",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289082430",
      "ndc_label_name": "Fluconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111014601",
      "ndc_label_name": "Fluconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268033915",
      "ndc_label_name": "Fluconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959074530",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714069302",
      "ndc_label_name": "Fluconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135013330",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788715003",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788715002",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001025404",
      "ndc_label_name": "Fluconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289082420",
      "ndc_label_name": "Fluconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407042701",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739011510",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319603",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559099330",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848302",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710114001",
      "ndc_label_name": "Fluconazole TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084073511",
      "ndc_label_name": "Fluconazole TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629909101",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237000601",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822009",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268033911",
      "ndc_label_name": "Fluconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187087830",
      "ndc_label_name": "Fluconazole TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848308",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014630",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822000",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788715009",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762501801",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852601",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407030230",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629194901",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852603",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852606",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848309",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822001",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049303",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205028330",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629874901",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67405060403",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462010430",
      "ndc_label_name": "Fluconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771039901",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852600",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822006",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788715000",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771039930",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084073501",
      "ndc_label_name": "Fluconazole TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848301",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788715005",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822008",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852609",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852602",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822002",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852608",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788715001",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205010430",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788715006",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710114003",
      "ndc_label_name": "Fluconazole TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822003",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848300",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848303",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848306",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189051603",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804003030",
      "ndc_label_name": "Fluconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111014301",
      "ndc_label_name": "Fluconazole TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407029930",
      "ndc_label_name": "Fluconazole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629195001",
      "ndc_label_name": "Fluconazole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714069401",
      "ndc_label_name": "Fluconazole TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343008530",
      "ndc_label_name": "Fluconazole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571021010",
      "ndc_label_name": "Fluconazole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162177602",
      "ndc_label_name": "Fluconazole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407042430",
      "ndc_label_name": "Fluconazole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462010130",
      "ndc_label_name": "Fluconazole TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771039630",
      "ndc_label_name": "Fluconazole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237000330",
      "ndc_label_name": "Fluconazole TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111014330",
      "ndc_label_name": "Fluconazole TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135013030",
      "ndc_label_name": "Fluconazole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629897001",
      "ndc_label_name": "Fluconazole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559099030",
      "ndc_label_name": "Fluconazole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67405060103",
      "ndc_label_name": "Fluconazole Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710113703",
      "ndc_label_name": "Fluconazole TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001025104",
      "ndc_label_name": "Fluconazole TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904731706",
      "ndc_label_name": "Fludrocortisone Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954025230",
      "ndc_label_name": "Fludrocortisone Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084028865",
      "ndc_label_name": "Fludrocortisone Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115703302",
      "ndc_label_name": "Fludrocortisone Acetate TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291076401",
      "ndc_label_name": "Fludrocortisone Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291052901",
      "ndc_label_name": "Fludrocortisone Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115703301",
      "ndc_label_name": "Fludrocortisone Acetate TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629880601",
      "ndc_label_name": "Fludrocortisone Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904731761",
      "ndc_label_name": "Fludrocortisone Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335245401",
      "ndc_label_name": "Fludrocortisone Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578016405",
      "ndc_label_name": "Fludrocortisone Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603017001",
      "ndc_label_name": "Fludrocortisone Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407070501",
      "ndc_label_name": "Fludrocortisone Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578016401",
      "ndc_label_name": "Fludrocortisone Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555099702",
      "ndc_label_name": "Fludrocortisone Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268033015",
      "ndc_label_name": "Fludrocortisone Acetate TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268033011",
      "ndc_label_name": "Fludrocortisone Acetate TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084028801",
      "ndc_label_name": "Fludrocortisone Acetate TABLET 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954025220",
      "ndc_label_name": "Fludrocortisone Acetate Tablet 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084028811",
      "ndc_label_name": "Fludrocortisone Acetate TABLET 0.1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "19515081852",
      "ndc_label_name": "Flulaval Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "19515080852",
      "ndc_label_name": "Flulaval Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "19515081452",
      "ndc_label_name": "Flulaval Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "19515080841",
      "ndc_label_name": "Flulaval Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "19515081841",
      "ndc_label_name": "Flulaval Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "19515081441",
      "ndc_label_name": "Flulaval Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "19515081052",
      "ndc_label_name": "Flulaval Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "19515090441",
      "ndc_label_name": "Flulaval Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "19515081041",
      "ndc_label_name": "Flulaval Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "19515090452",
      "ndc_label_name": "Flulaval Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66019031010",
      "ndc_label_name": "FluMist Quadrivalent Suspension Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162070486",
      "ndc_label_name": "Fluocinolone Acetonide Body Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13925050604",
      "ndc_label_name": "Fluocinolone Acetonide Body Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980033104",
      "ndc_label_name": "Fluocinolone Acetonide Body OIL 0.01 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162143402",
      "ndc_label_name": "Fluocinolone Acetonide Body Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462059189",
      "ndc_label_name": "Fluocinolone Acetonide Body Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752015606",
      "ndc_label_name": "Fluocinolone Acetonide Body Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802088726",
      "ndc_label_name": "Fluocinolone Acetonide Body Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672135608",
      "ndc_label_name": "Fluocinolone Acetonide Body OIL 0.01 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335288401",
      "ndc_label_name": "Fluocinolone Acetonide Body Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629865501",
      "ndc_label_name": "Fluocinolone Acetonide Body Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162231902",
      "ndc_label_name": "Fluocinolone Acetonide Body Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713070915",
      "ndc_label_name": "Fluocinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168006060",
      "ndc_label_name": "Fluocinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713070960",
      "ndc_label_name": "Fluocinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168006015",
      "ndc_label_name": "Fluocinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559028915",
      "ndc_label_name": "Fluocinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959018401",
      "ndc_label_name": "Fluocinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559028960",
      "ndc_label_name": "Fluocinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559029915",
      "ndc_label_name": "Fluocinolone Acetonide Ointment 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713022415",
      "ndc_label_name": "Fluocinolone Acetonide OINTMENT 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168006460",
      "ndc_label_name": "Fluocinolone Acetonide OINTMENT 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168006415",
      "ndc_label_name": "Fluocinolone Acetonide OINTMENT 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713022460",
      "ndc_label_name": "Fluocinolone Acetonide OINTMENT 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559029960",
      "ndc_label_name": "Fluocinolone Acetonide Ointment 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090678000",
      "ndc_label_name": "Fluocinolone Acetonide Scalp Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629865601",
      "ndc_label_name": "Fluocinolone Acetonide Scalp Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980033004",
      "ndc_label_name": "Fluocinolone Acetonide Scalp OIL 0.01 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13925050704",
      "ndc_label_name": "Fluocinolone Acetonide Scalp Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162070386",
      "ndc_label_name": "Fluocinolone Acetonide Scalp Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162232102",
      "ndc_label_name": "Fluocinolone Acetonide Scalp Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802048526",
      "ndc_label_name": "Fluocinolone Acetonide Scalp Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462059089",
      "ndc_label_name": "Fluocinolone Acetonide Scalp Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672135708",
      "ndc_label_name": "Fluocinolone Acetonide Scalp OIL 0.01 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335288301",
      "ndc_label_name": "Fluocinolone Acetonide Scalp Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752015806",
      "ndc_label_name": "Fluocinolone Acetonide Scalp Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162141202",
      "ndc_label_name": "Fluocinolone Acetonide Scalp Oil 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093026292",
      "ndc_label_name": "Fluocinonide CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093026230",
      "ndc_label_name": "Fluocinonide CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922006403",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090259600",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713066315",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178400",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093026215",
      "ndc_label_name": "Fluocinonide CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922006404",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090630900",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713066360",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090241900",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298200",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713066331",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238153403",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922006407",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922006405",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238153402",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090274100",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862049415",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090327700",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672125302",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238153406",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788810503",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999017230",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672138602",
      "ndc_label_name": "Fluocinonide CREAM 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672125303",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002092063",
      "ndc_label_name": "Fluocinonide CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090792300",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002092068",
      "ndc_label_name": "Fluocinonide CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009301",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788859306",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672138603",
      "ndc_label_name": "Fluocinonide CREAM 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71085000560",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205009215",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672125301",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862049460",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672125304",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672138601",
      "ndc_label_name": "Fluocinonide CREAM 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672138604",
      "ndc_label_name": "Fluocinonide CREAM 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862049430",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009302",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009303",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002092066",
      "ndc_label_name": "Fluocinonide CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700055415",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267097315",
      "ndc_label_name": "Fluocinonide CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238153405",
      "ndc_label_name": "Fluocinonide Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672125401",
      "ndc_label_name": "Fluocinonide Emulsified Base CREAM 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093026315",
      "ndc_label_name": "Fluocinonide Emulsified Base CREAM 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093026392",
      "ndc_label_name": "Fluocinonide Emulsified Base CREAM 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093026330",
      "ndc_label_name": "Fluocinonide Emulsified Base CREAM 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713066460",
      "ndc_label_name": "Fluocinonide Emulsified Base Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713066415",
      "ndc_label_name": "Fluocinonide Emulsified Base Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713066431",
      "ndc_label_name": "Fluocinonide Emulsified Base Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672125402",
      "ndc_label_name": "Fluocinonide Emulsified Base CREAM 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672125403",
      "ndc_label_name": "Fluocinonide Emulsified Base CREAM 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168013560",
      "ndc_label_name": "Fluocinonide Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802076160",
      "ndc_label_name": "Fluocinonide Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168013515",
      "ndc_label_name": "Fluocinonide Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672127902",
      "ndc_label_name": "Fluocinonide Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672127903",
      "ndc_label_name": "Fluocinonide Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672127901",
      "ndc_label_name": "Fluocinonide Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802076115",
      "ndc_label_name": "Fluocinonide Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781053326",
      "ndc_label_name": "Fluocinonide Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802076130",
      "ndc_label_name": "Fluocinonide Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512003460",
      "ndc_label_name": "Fluocinonide Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065260",
      "ndc_label_name": "Fluocinonide Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781053372",
      "ndc_label_name": "Fluocinonide Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781053373",
      "ndc_label_name": "Fluocinonide Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714050202",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093026415",
      "ndc_label_name": "Fluocinonide OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093026492",
      "ndc_label_name": "Fluocinonide OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714050201",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781056973",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700014617",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714050203",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093026430",
      "ndc_label_name": "Fluocinonide OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959031503",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781056926",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629233901",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672126401",
      "ndc_label_name": "Fluocinonide OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629233801",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959031501",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672126402",
      "ndc_label_name": "Fluocinonide OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781056972",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672126403",
      "ndc_label_name": "Fluocinonide OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855406",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002096866",
      "ndc_label_name": "Fluocinonide OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629233701",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162197203",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002096863",
      "ndc_label_name": "Fluocinonide OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162197206",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162197202",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700014615",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700014616",
      "ndc_label_name": "Fluocinonide Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922000101",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168013460",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342032084",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386002602",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672127302",
      "ndc_label_name": "Fluocinonide SOLUTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781060226",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629958301",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781060249",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386002606",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342032085",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162249002",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672127304",
      "ndc_label_name": "Fluocinonide SOLUTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002076863",
      "ndc_label_name": "Fluocinonide SOLUTION 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980045206",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162249006",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752015405",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710128403",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162214606",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603070301",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71085000660",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71428000160",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162127006",
      "ndc_label_name": "Fluocinonide Solution 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219158503",
      "ndc_label_name": "Fluorometholone Suspension 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219158606",
      "ndc_label_name": "Fluorometholone Suspension 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60758088005",
      "ndc_label_name": "Fluorometholone SUSPENSION 0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60758088010",
      "ndc_label_name": "Fluorometholone SUSPENSION 0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862036240",
      "ndc_label_name": "Fluorouracil Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378479106",
      "ndc_label_name": "Fluorouracil CREAM 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090426400",
      "ndc_label_name": "Fluorouracil Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672411806",
      "ndc_label_name": "Fluorouracil CREAM 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714017801",
      "ndc_label_name": "Fluorouracil Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729054235",
      "ndc_label_name": "Fluorouracil Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21922004917",
      "ndc_label_name": "Fluorouracil Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907009540",
      "ndc_label_name": "Fluorouracil Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66530024940",
      "ndc_label_name": "Fluorouracil Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904578461",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714072003",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714072002",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063730",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440753807",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714035101",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440753890",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440753814",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483070101",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155002810",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722090330",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090074900",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440753830",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063760",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904734561",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722090301",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090277600",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063057021",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291039601",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090074902",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781282301",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483070110",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722090305",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063057028",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001039908",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606502",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291039610",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606500",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155002801",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318002",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063057030",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111064701",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097400",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090619302",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011305",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090619300",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063057090",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111064703",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318000",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959066960",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097455",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090670202",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436092401",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011301",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011310",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651089800",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090670200",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002291",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097472",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111064702",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002130500",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011330",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700086690",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009930",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002130506",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629160902",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603048801",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919088530",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002130503",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959066930",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002231",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019201",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651089899",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001039900",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009010010",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008130",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919088590",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959066959",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001067008",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645013154",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629160903",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367023510",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781709",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304068630",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002430",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118064709",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241000705",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241000711",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019299",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097460",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068330",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267057630",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001067000",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304068690",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603048802",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781703",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097490",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781706",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771011301",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367023501",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771011310",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934035930",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934071030",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097411",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097430",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002460",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068360",
      "ndc_label_name": "FLUoxetine HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752130",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714072102",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904578561",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752181",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071290",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752160",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752114",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752107",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714072103",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356072890",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356072830",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781282210",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608103",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752185",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752128",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752190",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155002910",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291039710",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291039701",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722090401",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090722600",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483070201",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634075571",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904734661",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722090405",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012860",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012820",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356072860",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073214",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012814",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155002901",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714035201",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722090410",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256801",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012890",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483070210",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073215",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090074401",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071221",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608101",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071260",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111064844",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256800",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256803",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760028290",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090074500",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071230",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090657401",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012800",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011401",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111064803",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090722503",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919086930",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090074503",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090074400",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111064801",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090279300",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011430",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289061060",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011410",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919086960",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608100",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090074403",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111064802",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333200",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073220",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651089900",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655027426",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187006930",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090657400",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090074501",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002101600",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289061028",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073290",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019301",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073210",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187006960",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090657403",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090335501",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019399",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002331",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289061014",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645013054",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289061030",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629161002",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090698600",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073200",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544084845",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001067108",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760025990",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934049030",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629161008",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629161003",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090722500",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073230",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790906",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012530",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304068790",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092403",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019305",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629161007",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090722501",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073240",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788922309",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092401",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001040000",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002830",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544084892",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544084830",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073260",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073250",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934014130",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335202007",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001067100",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069960",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001040008",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544084870",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002101603",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651089999",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205017830",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002880",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084060511",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069970",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934007730",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544084880",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002101606",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760031190",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097572",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046460",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367023601",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069980",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061130",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084060501",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002391",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304068730",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092402",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046492",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367023610",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789054530",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335202001",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790909",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629161004",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629161001",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002870",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069953",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934071230",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009010110",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002860",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934083330",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629161005",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629161006",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189065630",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069992",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934071290",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008004790",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002892",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097590",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267048890",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267048860",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189065690",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603048901",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205017890",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544084853",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046430",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031303",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544084860",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790903",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771011401",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603048902",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002853",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097555",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241000805",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097560",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790901",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335202002",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031302",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046480",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061190",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069930",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789054590",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241000811",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097500",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008004730",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097511",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097530",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335202003",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046453",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046470",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771011410",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031301",
      "ndc_label_name": "FLUoxetine HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093719801",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099321",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099330",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714072204",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440753981",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781282401",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093719805",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440753990",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440753985",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483070303",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567800",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155003001",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781282410",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714072203",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093719856",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155003003",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781282431",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606401",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002491",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063083930",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714072202",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155003005",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483070350",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291039801",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722090501",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090791401",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187036130",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090258901",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155003010",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099390",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011501",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090723200",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722090530",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011530",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019499",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090789900",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063083990",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606400",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001067203",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011505",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291039850",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008930",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735609",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090791400",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090258900",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436092301",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010101",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651090030",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483070301",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304063230",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205039390",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071730",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090791500",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651090000",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097911",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049030",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567801",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001040100",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241000905",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687065901",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651090005",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651090099",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603049003",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002471",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090686300",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001067204",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019405",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049090",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687065911",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074530",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205039330",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019401",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019430",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367023701",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241000910",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002430",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001040103",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304063201",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771011505",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010111",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001040104",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097990",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735601",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002431",
      "ndc_label_name": "FLUoxetine HCl CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735603",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001067200",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861803",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735606",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367023705",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335056501",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097900",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934071430",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189050530",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861809",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603049001",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861801",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603049002",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205018830",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097960",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097930",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189006790",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097955",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771011501",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097972",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162222105",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009010205",
      "ndc_label_name": "FLUoxetine HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135073045",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832603212",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54838052340",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29033050331",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687024477",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121472105",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121072104",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135073024",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71656008904",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687084577",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687024467",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999073024",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862030612",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954060010",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999073045",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135073041",
      "ndc_label_name": "FLUoxetine HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023012989",
      "ndc_label_name": "FluPHENAZine Decanoate Solution 25 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143952901",
      "ndc_label_name": "FluPHENAZine Decanoate SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023012901",
      "ndc_label_name": "FluPHENAZine Decanoate SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021083805",
      "ndc_label_name": "fluPHENAZine Decanoate Solution 25 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205010001",
      "ndc_label_name": "fluPHENAZine Decanoate Solution 25 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323027205",
      "ndc_label_name": "FluPHENAZine Decanoate SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150026705",
      "ndc_label_name": "FluPHENAZine Decanoate Solution 25 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457035959",
      "ndc_label_name": "FluPHENAZine Decanoate Solution 25 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323028110",
      "ndc_label_name": "FluPHENAZine HCl SOLUTION 2.5 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832600311",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527178801",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268036611",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135072501",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571088909",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979013601",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714067201",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904715761",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241025501",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672423301",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238167801",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571088950",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598003401",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135041590",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505476801",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714000201",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710148801",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332078831",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083790",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291043501",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083730",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "90096012101",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083711",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268036615",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083760",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651068601",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083778",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407045801",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083764",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083700",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954027310",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083772",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083755",
      "ndc_label_name": "fluPHENAZine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832600611",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714000501",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135072801",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268036911",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651068901",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527179105",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527179101",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571089250",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571089209",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979013901",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268036915",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672423601",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084095001",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904716061",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241025201",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462033801",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714067501",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598003701",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687076111",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084078",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084030",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714067502",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238168101",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084072",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291043801",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687076101",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084000",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "90096012401",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084055",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651068905",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710149101",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084095011",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407046101",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135041990",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084090",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084011",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505477101",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332079131",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954027610",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084064",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710149105",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084060",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954027620",
      "ndc_label_name": "fluPHENAZine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904715861",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527178901",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571089050",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714067301",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710148901",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135072601",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241025401",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651068701",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979013701",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832600411",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291043601",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598003501",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083855",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571089009",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238167901",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505476901",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083830",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268036711",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083800",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268036715",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083864",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714000301",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083860",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332078931",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083878",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135041690",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "90096012201",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407045901",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083890",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954027410",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672423401",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083811",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462033601",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083872",
      "ndc_label_name": "fluPHENAZine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832600511",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904715961",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527179005",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135072701",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714067402",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571089150",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268036815",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527179001",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598003601",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407046001",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714067401",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571089109",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090342300",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135041890",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651068801",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291043701",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083972",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672423501",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979013801",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714000401",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332079031",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083960",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083990",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505477001",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954027510",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084084601",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651068805",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241025301",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084084611",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710149001",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238168001",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462033701",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710149005",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083900",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083978",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268036811",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083911",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083964",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083930",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687074901",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "90096012301",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687074911",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954027520",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083955",
      "ndc_label_name": "fluPHENAZine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58223051724",
      "ndc_label_name": "Flura-Drops Solution 0.55 (0.25 F) MG/DROP Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959036930",
      "ndc_label_name": "Flurazepam HCl Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959036940",
      "ndc_label_name": "Flurazepam HCl Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440753030",
      "ndc_label_name": "Flurazepam HCl Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378441501",
      "ndc_label_name": "Flurazepam HCl Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959036900",
      "ndc_label_name": "Flurazepam HCl Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135073630",
      "ndc_label_name": "Flurazepam HCl Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959036960",
      "ndc_label_name": "Flurazepam HCl Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959036906",
      "ndc_label_name": "Flurazepam HCl Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071022020",
      "ndc_label_name": "Flurazepam HCl Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071022030",
      "ndc_label_name": "Flurazepam HCl Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135073690",
      "ndc_label_name": "Flurazepam HCl Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378443001",
      "ndc_label_name": "Flurazepam HCl Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023660",
      "ndc_label_name": "Flurazepam HCl Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289003830",
      "ndc_label_name": "Flurazepam HCl Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023630",
      "ndc_label_name": "Flurazepam HCl Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023614",
      "ndc_label_name": "Flurazepam HCl Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440753130",
      "ndc_label_name": "Flurazepam HCl Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356043030",
      "ndc_label_name": "Flurazepam HCl Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023615",
      "ndc_label_name": "Flurazepam HCl Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023620",
      "ndc_label_name": "Flurazepam HCl Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267033160",
      "ndc_label_name": "Flurazepam HCl Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267033115",
      "ndc_label_name": "Flurazepam HCl Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267033130",
      "ndc_label_name": "Flurazepam HCl Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135073730",
      "ndc_label_name": "Flurazepam HCl Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135073790",
      "ndc_label_name": "Flurazepam HCl Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267033145",
      "ndc_label_name": "Flurazepam HCl Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090394600",
      "ndc_label_name": "Flurbiprofen Sodium Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292072225",
      "ndc_label_name": "Flurbiprofen Sodium Solution 0.03 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959034620",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664016513",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034621",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099215",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093071101",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950021810",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093071105",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034630",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752920",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629880801",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788734101",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959034614",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788734106",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267048630",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440752930",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664016508",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788734109",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788734103",
      "ndc_label_name": "Flurbiprofen Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664016408",
      "ndc_label_name": "Flurbiprofen Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884075313",
      "ndc_label_name": "Flutamide Capsule 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429027218",
      "ndc_label_name": "Flutamide Capsule 125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063160",
      "ndc_label_name": "Fluticasone Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802022235",
      "ndc_label_name": "Fluticasone Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168033260",
      "ndc_label_name": "Fluticasone Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713072931",
      "ndc_label_name": "Fluticasone Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168033215",
      "ndc_label_name": "Fluticasone Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168033230",
      "ndc_label_name": "Fluticasone Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063115",
      "ndc_label_name": "Fluticasone Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356024615",
      "ndc_label_name": "Fluticasone Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713072915",
      "ndc_label_name": "Fluticasone Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090118700",
      "ndc_label_name": "Fluticasone Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063131",
      "ndc_label_name": "Fluticasone Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922007504",
      "ndc_label_name": "Fluticasone Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713072960",
      "ndc_label_name": "Fluticasone Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162140203",
      "ndc_label_name": "Fluticasone Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922007505",
      "ndc_label_name": "Fluticasone Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919093015",
      "ndc_label_name": "Fluticasone Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802022237",
      "ndc_label_name": "Fluticasone Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922007507",
      "ndc_label_name": "Fluticasone Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629865801",
      "ndc_label_name": "Fluticasone Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629866001",
      "ndc_label_name": "Fluticasone Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162140206",
      "ndc_label_name": "Fluticasone Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802022211",
      "ndc_label_name": "Fluticasone Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629865901",
      "ndc_label_name": "Fluticasone Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162140202",
      "ndc_label_name": "Fluticasone Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187095960",
      "ndc_label_name": "Fluticasone Propionate CREAM 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76519101806",
      "ndc_label_name": "Fluticasone Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090605800",
      "ndc_label_name": "Fluticasone Propionate HFA Aerosol 110 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993007996",
      "ndc_label_name": "Fluticasone Propionate HFA Aerosol 110 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993007896",
      "ndc_label_name": "Fluticasone Propionate HFA Aerosol 44 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876201",
      "ndc_label_name": "Fluticasone Propionate HFA Aerosol 44 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090605300",
      "ndc_label_name": "Fluticasone Propionate HFA Aerosol 44 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162140106",
      "ndc_label_name": "Fluticasone Propionate Ointment 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802022137",
      "ndc_label_name": "Fluticasone Propionate OINTMENT 0.005 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063260",
      "ndc_label_name": "Fluticasone Propionate OINTMENT 0.005 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629866201",
      "ndc_label_name": "Fluticasone Propionate Ointment 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063215",
      "ndc_label_name": "Fluticasone Propionate OINTMENT 0.005 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629866101",
      "ndc_label_name": "Fluticasone Propionate Ointment 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063231",
      "ndc_label_name": "Fluticasone Propionate OINTMENT 0.005 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802022135",
      "ndc_label_name": "Fluticasone Propionate OINTMENT 0.005 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802022111",
      "ndc_label_name": "Fluticasone Propionate OINTMENT 0.005 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162140102",
      "ndc_label_name": "Fluticasone Propionate Ointment 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629866301",
      "ndc_label_name": "Fluticasone Propionate Ointment 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162140103",
      "ndc_label_name": "Fluticasone Propionate Ointment 0.005 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536118365",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917018705",
      "ndc_label_name": "Fluticasone Propionate SUSPENSION 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00054327099",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536118313",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090248400",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090288000",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255700",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090641901",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429019515",
      "ndc_label_name": "Fluticasone Propionate SUSPENSION 50 MCG/ACT NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "36800022201",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536118321",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917018251",
      "ndc_label_name": "Fluticasone Propionate SUSPENSION 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58602001742",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090682300",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090351300",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505616701",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60432026415",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959095616",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536118399",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189000401",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205044316",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383070016",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436264001",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000416",
      "ndc_label_name": "Fluticasone Propionate SUSPENSION 50 MCG/ACT NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080616",
      "ndc_label_name": "Fluticasone Propionate SUSPENSION 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505082901",
      "ndc_label_name": "Fluticasone Propionate SUSPENSION 50 MCG/ACT NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11917018253",
      "ndc_label_name": "Fluticasone Propionate SUSPENSION 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69306001601",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788967801",
      "ndc_label_name": "Fluticasone Propionate SUSPENSION 50 MCG/ACT NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436999201",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700071416",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061101",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "36800057201",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "62135081061",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505620503",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788778801",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090096800",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788844601",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70000070301",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72888014135",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002076901",
      "ndc_label_name": "Fluticasone Propionate SUSPENSION 50 MCG/ACT NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700068016",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788765801",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425026301",
      "ndc_label_name": "Fluticasone Propionate Suspension 50 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054032656",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093751731",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993058497",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090421100",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870406",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093360882",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 113-14 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629880901",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 113-14 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090327100",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 113-14 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629881001",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 232-14 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090338700",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 232-14 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093360982",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 232-14 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205026260",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093751831",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993058597",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054032756",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090421300",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842606",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845306",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993058697",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 500-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054032856",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 500-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090421400",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 500-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093751631",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 500-50 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090327200",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 55-14 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629881101",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 55-14 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093360782",
      "ndc_label_name": "Fluticasone-Salmeterol Aerosol Powder Breath Activated 55-14 MCG/ACT Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559016001",
      "ndc_label_name": "FluvoxaMINE Maleate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832167211",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788401103",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356003130",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452045520",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505016601",
      "ndc_label_name": "FluvoxaMINE Maleate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135093330",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721909",
      "ndc_label_name": "FluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817506",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817509",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788401106",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090598800",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789022130",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788401109",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721903",
      "ndc_label_name": "FluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090772800",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817503",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721906",
      "ndc_label_name": "FluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452028920",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026402",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832167011",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452028720",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452045420",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505016401",
      "ndc_label_name": "FluvoxaMINE Maleate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135093190",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356002930",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559015801",
      "ndc_label_name": "FluvoxaMINE Maleate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135093260",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832167111",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452028820",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505016501",
      "ndc_label_name": "FluvoxaMINE Maleate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356003030",
      "ndc_label_name": "fluvoxaMINE Maleate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559015901",
      "ndc_label_name": "FluvoxaMINE Maleate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49281063978",
      "ndc_label_name": "Fluzone Quadrivalent Suspension Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69112000017",
      "ndc_label_name": "Flyp HypersoniQ Cartridge",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66758025001",
      "ndc_label_name": "Focalin Tablet 2.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00078038005",
      "ndc_label_name": "Focalin Tablet 2.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991008290",
      "ndc_label_name": "Folbee Plus Tablet Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440754590",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440754530",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353068160",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135018210",
      "ndc_label_name": "Folic Acid TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079190",
      "ndc_label_name": "Folic Acid TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534016503",
      "ndc_label_name": "Folic Acid TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090279700",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534016501",
      "ndc_label_name": "Folic Acid TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904722461",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788000101",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353068165",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353068130",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353038660",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571088101",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090719400",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353038665",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135018201",
      "ndc_label_name": "Folic Acid TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353038630",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082465",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999043360",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090260402",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571088110",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293084601",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45861007101",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11788000110",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999043330",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090260400",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090260404",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090311900",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079130",
      "ndc_label_name": "Folic Acid TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584089711",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54629012810",
      "ndc_label_name": "Folic Acid TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090020000",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090020002",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090415200",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090311904",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090611200",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090311902",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705301",
      "ndc_label_name": "Folic Acid TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068101",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090719404",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090719402",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090676000",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268034515",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746036101",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268034511",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752020411",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267021730",
      "ndc_label_name": "Folic Acid TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090719500",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094011261",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51293084610",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657015101",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289049290",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746036110",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934059730",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788695001",
      "ndc_label_name": "Folic Acid TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289049230",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882709",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54629012800",
      "ndc_label_name": "Folic Acid TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "62135021001",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657015110",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154206400",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091311",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762406",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068111",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080330",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135021072",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629925801",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629925701",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135021090",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335285801",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855701",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135021005",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162165100",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584089701",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125012701",
      "ndc_label_name": "Folic Acid TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162036110",
      "ndc_label_name": "Folic Acid TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094011259",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71610065660",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315012701",
      "ndc_label_name": "Folic Acid TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135021010",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162241301",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544098930",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162036111",
      "ndc_label_name": "Folic Acid TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544098960",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762403",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095212",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752020410",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125012710",
      "ndc_label_name": "Folic Acid TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73152014101",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544098965",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882701",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705303",
      "ndc_label_name": "Folic Acid TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855706",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241005005",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091300",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762409",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85633004101",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788882706",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091330",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705306",
      "ndc_label_name": "Folic Acid TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335061301",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73152014110",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091360",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855709",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85633004124",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70752023111",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071630",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705309",
      "ndc_label_name": "Folic Acid TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071660",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023530",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054560",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091390",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080353",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162165102",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162165101",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762401",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162232200",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162255600",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095213",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023560",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85633004136",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "82804011030",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162255601",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855703",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85633004100",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71610023565",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882703",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054530",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315012710",
      "ndc_label_name": "Folic Acid TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080360",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752023110",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162241300",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091355",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85633004105",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335076601",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85633004130",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71610065630",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095204",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095230",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095260",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162232201",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162255700",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189019930",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241005011",
      "ndc_label_name": "Folic Acid Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135018001",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056012",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917013956",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00761087840",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917007952",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11845006531",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "35046000272",
      "ndc_label_name": "Folic Acid Tablet 400 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917003564",
      "ndc_label_name": "Folic Acid Tablet 400 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135018010",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58487001633",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40985021377",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917003960",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268034611",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30768003557",
      "ndc_label_name": "Folic Acid Tablet 400 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268034615",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80681009900",
      "ndc_label_name": "Folic Acid Tablet 400 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917003920",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "74312001403",
      "ndc_label_name": "Folic Acid Tablet 400 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58487001631",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "31604001274",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54629065002",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864093201",
      "ndc_label_name": "Folic Acid Tablet 400 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "84781087201",
      "ndc_label_name": "Folic Acid Tablet 400 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54738014001",
      "ndc_label_name": "Folic Acid Tablet 400 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056383",
      "ndc_label_name": "Folic Acid Tablet 400 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "78742049911",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295010245",
      "ndc_label_name": "Folic Acid Tablet 400 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295013565",
      "ndc_label_name": "Folic Acid Tablet 400 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292055910",
      "ndc_label_name": "Folic Acid TABLET 400 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "74312001400",
      "ndc_label_name": "Folic Acid Tablet 400 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864093310",
      "ndc_label_name": "Folic Acid Tablet 800 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135018101",
      "ndc_label_name": "Folic Acid TABLET 800 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11845006761",
      "ndc_label_name": "Folic Acid TABLET 800 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292012354",
      "ndc_label_name": "Folic Acid TABLET 800 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268034415",
      "ndc_label_name": "Folic Acid TABLET 800 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58487001471",
      "ndc_label_name": "Folic Acid TABLET 800 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30768000676",
      "ndc_label_name": "Folic Acid TABLET 800 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135018110",
      "ndc_label_name": "Folic Acid TABLET 800 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40985022563",
      "ndc_label_name": "Folic Acid TABLET 800 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96121000239",
      "ndc_label_name": "Folic Acid TABLET 800 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40093010148",
      "ndc_label_name": "Folic Acid TABLET 800 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58487001472",
      "ndc_label_name": "Folic Acid TABLET 800 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "74312002843",
      "ndc_label_name": "Folic Acid TABLET 800 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "35046000273",
      "ndc_label_name": "Folic Acid Tablet 800 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268034411",
      "ndc_label_name": "Folic Acid TABLET 800 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54629026001",
      "ndc_label_name": "Folic Acid TABLET 800 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80681007400",
      "ndc_label_name": "Folic Acid Tablet 800 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94604010473",
      "ndc_label_name": "Folic Acid TABLET 800 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131007164",
      "ndc_label_name": "Folic Acid TABLET 800 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131069708",
      "ndc_label_name": "Folic Acid TABLET 800 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00185538076",
      "ndc_label_name": "Foltrin Capsule Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598060602",
      "ndc_label_name": "Fondaparinux Sodium Solution 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111068102",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781347612",
      "ndc_label_name": "Fondaparinux Sodium Solution 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781347695",
      "ndc_label_name": "Fondaparinux Sodium Solution 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598060610",
      "ndc_label_name": "Fondaparinux Sodium Solution 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111068110",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457058500",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023300",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710151709",
      "ndc_label_name": "Fondaparinux Sodium Solution 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023310",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710151706",
      "ndc_label_name": "Fondaparinux Sodium Solution 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457058508",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 10 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781344395",
      "ndc_label_name": "Fondaparinux Sodium Solution 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781344312",
      "ndc_label_name": "Fondaparinux Sodium Solution 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598060702",
      "ndc_label_name": "Fondaparinux Sodium Solution 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457058200",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598060710",
      "ndc_label_name": "Fondaparinux Sodium Solution 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111067810",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023000",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457058210",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111067802",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710151409",
      "ndc_label_name": "Fondaparinux Sodium Solution 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023010",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710151406",
      "ndc_label_name": "Fondaparinux Sodium Solution 2.5 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598060802",
      "ndc_label_name": "Fondaparinux Sodium Solution 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781345412",
      "ndc_label_name": "Fondaparinux Sodium Solution 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710151506",
      "ndc_label_name": "Fondaparinux Sodium Solution 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457058300",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111067902",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111067910",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598060810",
      "ndc_label_name": "Fondaparinux Sodium Solution 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781345495",
      "ndc_label_name": "Fondaparinux Sodium Solution 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023100",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710151509",
      "ndc_label_name": "Fondaparinux Sodium Solution 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023110",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457058304",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 5 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111068010",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023200",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710151606",
      "ndc_label_name": "Fondaparinux Sodium Solution 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598060910",
      "ndc_label_name": "Fondaparinux Sodium Solution 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781346595",
      "ndc_label_name": "Fondaparinux Sodium Solution 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781346512",
      "ndc_label_name": "Fondaparinux Sodium Solution 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710151609",
      "ndc_label_name": "Fondaparinux Sodium Solution 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457058406",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598060902",
      "ndc_label_name": "Fondaparinux Sodium Solution 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150023210",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111068002",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457058400",
      "ndc_label_name": "Fondaparinux Sodium SOLUTION 7.5 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63304058360",
      "ndc_label_name": "Fosamprenavir Calcium Tablet 700 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378352091",
      "ndc_label_name": "Fosamprenavir Calcium TABLET 700 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032715",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555060",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555081",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555090",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555030",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555000",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555085",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555045",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547038609",
      "ndc_label_name": "Fosinopril Sodium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722020010",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090297700",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755090",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090344400",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547038611",
      "ndc_label_name": "Fosinopril Sodium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135004190",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755045",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282020090",
      "ndc_label_name": "Fosinopril Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090378000",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097085605",
      "ndc_label_name": "Fosinopril Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032711",
      "ndc_label_name": "Fosinopril Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282020010",
      "ndc_label_name": "Fosinopril Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862047190",
      "ndc_label_name": "Fosinopril Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555190",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555181",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555160",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555130",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755145",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547038711",
      "ndc_label_name": "Fosinopril Sodium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555100",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555145",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755190",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862047290",
      "ndc_label_name": "Fosinopril Sodium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032811",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555185",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547038709",
      "ndc_label_name": "Fosinopril Sodium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771701",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097085705",
      "ndc_label_name": "Fosinopril Sodium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722020110",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771703",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032815",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335018701",
      "ndc_label_name": "Fosinopril Sodium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135004290",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771706",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771709",
      "ndc_label_name": "Fosinopril Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282020190",
      "ndc_label_name": "Fosinopril Sodium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282020110",
      "ndc_label_name": "Fosinopril Sodium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335018702",
      "ndc_label_name": "Fosinopril Sodium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755245",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755292",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555230",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090342800",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555281",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555260",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555245",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555200",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755290",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547038809",
      "ndc_label_name": "Fosinopril Sodium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555285",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090474301",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032915",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440555290",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090250001",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087045",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090250000",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135004390",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722020210",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547038811",
      "ndc_label_name": "Fosinopril Sodium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862047390",
      "ndc_label_name": "Fosinopril Sodium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032911",
      "ndc_label_name": "Fosinopril Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097085805",
      "ndc_label_name": "Fosinopril Sodium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282020210",
      "ndc_label_name": "Fosinopril Sodium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282020290",
      "ndc_label_name": "Fosinopril Sodium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862030801",
      "ndc_label_name": "Fosinopril Sodium-HCTZ TABLET 10-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237002601",
      "ndc_label_name": "Fosinopril Sodium-HCTZ Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097097207",
      "ndc_label_name": "Fosinopril Sodium-HCTZ Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237002701",
      "ndc_label_name": "Fosinopril Sodium-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862030901",
      "ndc_label_name": "Fosinopril Sodium-HCTZ TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097097307",
      "ndc_label_name": "Fosinopril Sodium-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069021702",
      "ndc_label_name": "Fragmin Solution Prefilled Syringe 10000 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069021701",
      "ndc_label_name": "Fragmin Solution Prefilled Syringe 10000 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069022001",
      "ndc_label_name": "Fragmin Solution Prefilled Syringe 12500 UNIT/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069022002",
      "ndc_label_name": "Fragmin Solution Prefilled Syringe 12500 UNIT/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069022302",
      "ndc_label_name": "Fragmin Solution Prefilled Syringe 15000 UNIT/0.6ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069022301",
      "ndc_label_name": "Fragmin Solution Prefilled Syringe 15000 UNIT/0.6ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069022802",
      "ndc_label_name": "Fragmin Solution Prefilled Syringe 18000 UNT/0.72ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069022801",
      "ndc_label_name": "Fragmin Solution Prefilled Syringe 18000 UNT/0.72ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069019502",
      "ndc_label_name": "Fragmin Solution Prefilled Syringe 2500 UNIT/0.2ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069019501",
      "ndc_label_name": "Fragmin Solution Prefilled Syringe 2500 UNIT/0.2ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069019601",
      "ndc_label_name": "Fragmin Solution Prefilled Syringe 5000 UNIT/0.2ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069019602",
      "ndc_label_name": "Fragmin Solution Prefilled Syringe 5000 UNIT/0.2ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069020601",
      "ndc_label_name": "Fragmin Solution Prefilled Syringe 7500 UNIT/0.3ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069020602",
      "ndc_label_name": "Fragmin Solution Prefilled Syringe 7500 UNIT/0.3ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57599000200",
      "ndc_label_name": "FreeStyle Libre 14 Day Reader Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57599000101",
      "ndc_label_name": "FreeStyle Libre 14 Day Sensor",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57599083500",
      "ndc_label_name": "FreeStyle Libre 2 Plus Sensor",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57599080300",
      "ndc_label_name": "FreeStyle Libre 2 Reader Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57599080000",
      "ndc_label_name": "FreeStyle Libre 2 Sensor",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57599084400",
      "ndc_label_name": "FreeStyle Libre 3 Plus Sensor",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090710000",
      "ndc_label_name": "FreeStyle Libre 3 Reader Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57599082000",
      "ndc_label_name": "FreeStyle Libre 3 Reader Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57599000021",
      "ndc_label_name": "FreeStyle Libre Reader Device",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57599000019",
      "ndc_label_name": "FreeStyle Libre Sensor System",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "07411089003",
      "ndc_label_name": "Full Kit Nebulizer Set",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83257000541",
      "ndc_label_name": "Fulphila Solution Prefilled Syringe 6 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67457083306",
      "ndc_label_name": "Fulphila Solution Prefilled Syringe 6 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432061304",
      "ndc_label_name": "Furosemide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054329446",
      "ndc_label_name": "Furosemide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094075659",
      "ndc_label_name": "Furosemide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094075662",
      "ndc_label_name": "Furosemide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054329450",
      "ndc_label_name": "Furosemide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432061360",
      "ndc_label_name": "Furosemide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054329863",
      "ndc_label_name": "Furosemide SOLUTION 8 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094086759",
      "ndc_label_name": "Furosemide SOLUTION 8 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094086762",
      "ndc_label_name": "Furosemide SOLUTION 8 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440755520",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054829725",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755506",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054429731",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378020810",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755510",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054429725",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755530",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904717761",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755560",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755590",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046810",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070230",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755594",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378020801",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084930",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063080630",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135083210",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135083201",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046890",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022060",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046801",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070279",
      "ndc_label_name": "Furosemide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073792",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084921",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135083290",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070221",
      "ndc_label_name": "Furosemide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084960",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073780",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070260",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070290",
      "ndc_label_name": "Furosemide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074780",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073760",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084990",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073753",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073745",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256001",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063080621",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074760",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090621908",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999017940",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022030",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040111",
      "ndc_label_name": "Furosemide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074745",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090542900",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063080690",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999017910",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090664207",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999017990",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022080",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256008",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074753",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770601",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022045",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999017960",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919044230",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333801",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022092",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090542901",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074792",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651079601",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022053",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090542908",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561016409",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333807",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074730",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090542907",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040110",
      "ndc_label_name": "Furosemide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919044290",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073730",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090664208",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629121401",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073930",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090621900",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090622100",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333800",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125011610",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333808",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770800",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980056201",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980056210",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770608",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770600",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090621901",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267009730",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090664200",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002060500",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788694806",
      "ndc_label_name": "Furosemide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267009760",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407011390",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079007220",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090621907",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788694803",
      "ndc_label_name": "Furosemide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090664201",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919024290",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788694809",
      "ndc_label_name": "Furosemide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726503",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002060530",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407011301",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090694200",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315011601",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919024230",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304062401",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028430",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726506",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348013120",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407011310",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079007201",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028460",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073960",
      "ndc_label_name": "Furosemide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267009790",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028453",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726509",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561016401",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348013130",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959049930",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162136001",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629121501",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887009",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063553",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060104",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071170801",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760070790",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700046130",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003060",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726501",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518005002",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063560",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063545",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788694801",
      "ndc_label_name": "Furosemide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135075390",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651079699",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000210",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887001",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009645",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073910",
      "ndc_label_name": "Furosemide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084330",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315011610",
      "ndc_label_name": "Furosemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060102",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073990",
      "ndc_label_name": "Furosemide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028480",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887006",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060107",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561016402",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030960",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518005000",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030953",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887003",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063530",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060103",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030992",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934011130",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063592",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060105",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934041230",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060108",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060101",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009630",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060106",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009653",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030930",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030945",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030980",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009660",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084380",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063580",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009680",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162136000",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084353",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000201",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084360",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003030",
      "ndc_label_name": "Furosemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378021601",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046901",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006960",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378021610",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755604",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054429931",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054429925",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755607",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755692",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006909",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034153",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755630",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755660",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054829925",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090232301",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135083390",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001845",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006980",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326203",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755694",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135083310",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755690",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333901",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046910",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006930",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022153",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326209",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071601",
      "ndc_label_name": "Furosemide TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001860",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904717861",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090345501",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071630",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006953",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022160",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002043030",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001830",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006945",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135083301",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090664609",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071660",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034160",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034130",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700045230",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022130",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022180",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291046990",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770300",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022145",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040211",
      "ndc_label_name": "Furosemide TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034180",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025590",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034145",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090664603",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071690",
      "ndc_label_name": "Furosemide TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770401",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022192",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090331303",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090411100",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135075490",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090232309",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760085890",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001853",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770500",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022194",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770303",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090570201",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187079007",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090294600",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187079090",
      "ndc_label_name": "Furosemide TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001880",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788678409",
      "ndc_label_name": "Furosemide TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326200",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407011401",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407011410",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304062510",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090331300",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125011710",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040210",
      "ndc_label_name": "Furosemide TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735409",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326201",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348013330",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075100",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561016501",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333909",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788678403",
      "ndc_label_name": "Furosemide TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090232300",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315011701",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090331309",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348013340",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075115",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629121701",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090570600",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788678406",
      "ndc_label_name": "Furosemide TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090331301",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335039702",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090664601",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154554000",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075130",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980056310",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090664600",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004945",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333900",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095160",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770301",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651079701",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002043000",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879901",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090664701",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030830",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333903",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879906",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079007301",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760070890",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304062501",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335039703",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079007320",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063480",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090693700",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335039706",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407011490",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267009860",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561016502",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335039707",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651079799",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095180",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770309",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004980",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025530",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879903",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267009830",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030880",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760021790",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000301",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187079030",
      "ndc_label_name": "Furosemide TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063430",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561016509",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335039701",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735403",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095130",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028490",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030853",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267009890",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162136100",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980056301",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063460",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735406",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789015701",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629121601",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003260",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934043930",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879909",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315011710",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125011701",
      "ndc_label_name": "Furosemide TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004960",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335039708",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335039705",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788678401",
      "ndc_label_name": "Furosemide TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063453",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004930",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030845",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735401",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095145",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063445",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095153",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335039704",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162136101",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000310",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003230",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004953",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030860",
      "ndc_label_name": "Furosemide Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054830125",
      "ndc_label_name": "Furosemide TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755792",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378023201",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291047001",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054430125",
      "ndc_label_name": "Furosemide TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054430129",
      "ndc_label_name": "Furosemide TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755790",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999022530",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040350",
      "ndc_label_name": "Furosemide TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135083405",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135083401",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079052701",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407011501",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999022560",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040310",
      "ndc_label_name": "Furosemide TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561016609",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090271300",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291047050",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651079805",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315011805",
      "ndc_label_name": "Furosemide TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030580",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079052720",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629111901",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629112001",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304062601",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651079801",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980056401",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063645",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063630",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407011505",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315011801",
      "ndc_label_name": "Furosemide TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003360",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561016601",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304062605",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003301",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063653",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162136205",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980056450",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003330",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063660",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125011801",
      "ndc_label_name": "Furosemide TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561016605",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000401",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063680",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030560",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125011805",
      "ndc_label_name": "Furosemide TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162136201",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000405",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003382",
      "ndc_label_name": "Furosemide Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00004038140",
      "ndc_label_name": "Fuzeon Solution Reconstituted 90 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440755895",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755881",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755892",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064405",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086750",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755894",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904666561",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755885",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014805",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086710",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480349405",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155086605",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155086601",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086260",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064401",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014801",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014810",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582011410",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086701",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155086610",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385097211",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060550",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714066101",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066460",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385097201",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806050901",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582011418",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767200",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066490",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090094901",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714066102",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073192",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066430",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086298",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963055550",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228017901",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086280",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256100",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385097205",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090094900",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060527",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060510",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687500",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436081302",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060501",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090304600",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806050910",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090159700",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090094902",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060581",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436555001",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004710",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090159702",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228017905",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073198",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090358200",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256101",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090159701",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224001950",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004727",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090738803",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436081301",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086292",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090738800",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090738801",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320000",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700058401",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075727",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767203",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436126301",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963055511",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767300",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004718",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320002",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700058430",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075760",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075701",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075730",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060509",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228017910",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075780",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320003",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060530",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700095090",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075703",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760066990",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256102",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436081303",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700095001",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090738802",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010130",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762403001",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075720",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760092690",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320001",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075721",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060590",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090738900",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025272",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058001",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700095030",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025290",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090716900",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700058460",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380086707",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767201",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039200",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760074060",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058011",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187024830",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436126302",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060560",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019801",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767202",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039230",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760074090",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760092660",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739090210",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436126303",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760066930",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071022884",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224001960",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380075302",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760092630",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760093990",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380075301",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075702",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760081860",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731308",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004790",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877022205",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010172",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629848401",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380086706",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075790",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760081890",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788765103",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700095060",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777703",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025230",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019899",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788646101",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002147200",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019805",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777708",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760066960",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786909",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756013704",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731303",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788646108",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002147203",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071022845",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777709",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760093960",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819901",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187024890",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731305",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788765106",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700058490",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071022860",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786901",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010190",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819906",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162010111",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731306",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817606",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010160",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788646103",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786906",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025260",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856303",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071022890",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777706",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817609",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919066190",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788646106",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817603",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039290",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856306",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731309",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819403",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819409",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756013702",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788646109",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819909",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629848501",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856309",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772701",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819406",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819903",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756013705",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772703",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856301",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162010150",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097081307",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772708",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856308",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848901",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187024860",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817601",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010010801",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731301",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093016105",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777701",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367013106",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848908",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039203",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848909",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005760",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772709",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092860",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786903",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205037315",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097081312",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039260",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367013104",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005780",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012005",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092890",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786908",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205037390",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367034305",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739059110",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010010805",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013592",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205037330",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119803",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817608",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092855",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010092601",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162010110",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010010810",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042153",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205063890",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119804",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010092605",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092864",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092800",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877022201",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518261400",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162153201",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205066115",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335227901",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205018215",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092867",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007280",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877022210",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093016104",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189010972",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092876",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013580",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205063830",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092872",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012680",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071022830",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205018290",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189046072",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119802",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042160",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092830",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335165503",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013598",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788765108",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335116902",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000302",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335227902",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213805",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092878",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007292",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066730",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788765109",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119807",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189038490",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005792",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189010990",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335165502",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282032105",
      "ndc_label_name": "Gabapentin CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066753",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772706",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007260",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019901",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013560",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189046090",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335274101",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019904",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066792",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819401",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042130",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789012330",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066760",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819408",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007298",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789028930",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075653",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819908",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066780",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025227",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789012360",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848903",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012692",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025930",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162153205",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848906",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075630",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025990",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025960",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010092610",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025218",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012802",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213801",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012004",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213809",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804017890",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012803",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205031790",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025290",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000303",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189010930",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335165504",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189010960",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012660",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189041930",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189041972",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025905",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189046060",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189041960",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025901",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189041990",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015002",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000301",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019902",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019903",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789012390",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789028960",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025205",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015003",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804022630",
      "ndc_label_name": "Gabapentin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086850",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755960",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755901",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755981",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755990",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755985",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714066201",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582011518",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155086701",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480349505",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385097311",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755992",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755996",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755994",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014901",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063067330",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014905",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086801",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806051010",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440755995",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904666661",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155086705",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070930",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063067390",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356070805",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086810",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007594",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064501",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064505",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155086710",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082392",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007598",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806051001",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007530",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070953",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385097305",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714066202",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291030150",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086330",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082398",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007553",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007560",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070980",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070960",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385097301",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582011510",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060603",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086380",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007580",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082360",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082370",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070970",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063067360",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070992",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060610",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090089601",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070998",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086392",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086360",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090089608",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007592",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070994",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090259001",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090089602",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082330",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086394",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060609",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090259002",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086370",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082394",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090672803",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090672806",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999053918",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963055650",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060627",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090259003",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060681",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086353",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090672804",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075400",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090335300",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060601",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090089603",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090259005",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090089604",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086398",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742000",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700054401",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090672800",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060606",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090596100",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742001",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090089609",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963055611",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742005",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059101",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090672802",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090089600",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090672801",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742006",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090259000",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060650",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436022302",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760008891",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742009",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090089605",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436022301",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767400",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090284700",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090259006",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436022305",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760074160",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228018005",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090089606",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224011960",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767403",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742003",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090671800",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436728501",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760081490",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436728503",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090259004",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075460",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767405",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767402",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090672805",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004890",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760085790",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224011950",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090489300",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700094930",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436022303",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767404",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742002",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075402",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010271",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004810",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742004",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760008860",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436728502",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767409",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742008",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075490",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083960",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075463",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742100",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083930",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004818",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228018001",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436022304",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700054430",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083990",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762413505",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767401",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083971",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004827",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228018010",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436728506",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700094901",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919098272",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760081491",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767406",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919098271",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004830",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004860",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075408",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760067460",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629305601",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010290",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767408",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187003160",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075430",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700054460",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700094990",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010230",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629305602",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919098230",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767500",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037200",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700054490",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762413501",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760081460",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010260",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629305607",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187003100",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075420",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081030",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059111",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760067430",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064082",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919098290",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380075401",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081090",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075445",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629305600",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760067490",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919041760",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083972",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756013804",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877022310",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098800",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700094960",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629305605",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760074190",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919098260",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756013802",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037260",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788703808",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098860",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760008890",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629305606",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760085760",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629305604",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187003130",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629730605",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704300",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629305603",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760085730",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629305610",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919041790",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629305609",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037230",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629796202",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704400",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629730602",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010272",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162010211",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064030",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162010210",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037290",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629848601",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783903",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629848701",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064072",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071021230",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064060",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071021290",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629730603",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380086806",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783906",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739090310",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187003190",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071021291",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064090",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788702405",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629730606",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019999",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783909",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019901",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098890",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788703809",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083999",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788703800",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162010250",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788703803",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871203",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071021200",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629305608",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704306",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756013805",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704302",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862019905",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788703806",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518176009",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071021245",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739023610",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704403",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081060",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704308",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877022301",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788743103",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012104",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870302",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380075402",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704406",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629730601",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788743108",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071021207",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784801",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093016205",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870305",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380086807",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704409",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629730604",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783901",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071021214",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870304",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335126901",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870308",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877022305",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788743106",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071021284",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784809",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071021260",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094312",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335269901",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677020890",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788702400",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788743109",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071021292",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871202",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704408",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367034405",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006070",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518176006",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704303",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788744404",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788703802",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871204",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788744402",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010010905",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006098",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029530",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704304",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788744406",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788703804",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871205",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788744403",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010092705",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008830",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029560",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704309",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788744409",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788743102",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677020801",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870306",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012105",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012553",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335099301",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704401",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783905",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870300",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677020860",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870309",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029515",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012560",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335252102",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788743101",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783908",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870303",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518176008",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205053230",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205053214",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018530",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006060",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788743104",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784805",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871208",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029590",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205053260",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205053215",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018592",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006092",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783900",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784808",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871209",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205053290",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205053272",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092930",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018594",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008853",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784800",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871206",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69336010611",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205076630",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205076614",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119704",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018853",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012530",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784803",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677020830",
      "ndc_label_name": "Gabapentin CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367013204",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092976",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092964",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119709",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213902",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014360",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784806",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010092710",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69512010210",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119701",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335134802",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335134800",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005590",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018860",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871200",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093016204",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010010901",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119702",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149002",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335134805",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025305",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018894",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097094307",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092955",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010092701",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119707",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149005",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149004",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025318",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075370",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367013206",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092960",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205076690",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335228001",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335269909",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335199701",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004790",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075394",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010010910",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109301",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092967",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335269900",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006053",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335199702",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003301",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181307",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518297001",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119700",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092972",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335269903",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006080",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335228002",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007902",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181309",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092900",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119706",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092978",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008880",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012570",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006030",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007903",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213909",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092990",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149000",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119705",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008894",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014698",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009094",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804020690",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039260",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109306",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006094",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335134803",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012598",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018892",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018553",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335134804",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025360",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119703",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008892",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335134809",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014653",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018898",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018560",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335134810",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282062705",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119708",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008898",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149003",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014680",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181306",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018570",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149009",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003102",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335126904",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009053",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008860",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014692",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213905",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018580",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008870",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003203",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335126905",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009060",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012580",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021180",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005530",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021160",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014630",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003302",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335134801",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009080",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021170",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162153305",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005560",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021192",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021198",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003303",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149001",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014660",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162153301",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039282",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025330",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021194",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181308",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003305",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335200401",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018830",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213901",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005593",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025390",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075398",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039230",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014901",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335269902",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181301",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039272",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018203",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007901",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181304",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061030",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019603",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335269904",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181302",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061060",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000403",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804021730",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025327",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061072",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213903",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335269907",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004730",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061090",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004724",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009092",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003201",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005545",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003101",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012592",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014902",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004712",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003202",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014670",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019601",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003103",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003304",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018880",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000402",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003104",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018201",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039290",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804021790",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000401",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004760",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014903",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018202",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019602",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019604",
      "ndc_label_name": "Gabapentin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756185",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756181",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756192",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008160",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086910",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086480",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037260",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904666761",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086950",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806051101",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064601",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037280",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155086810",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086494",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086460",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064605",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714066302",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008192",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385097401",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037292",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015005",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963055711",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999054060",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086901",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155086805",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060750",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008180",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963055750",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582011610",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060701",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090210700",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714066301",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385097405",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228018101",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071080",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436022402",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071094",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060727",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004927",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155086801",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582011618",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436728403",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071092",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959081030",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081080",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228018105",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505011401",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015001",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060709",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224021950",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081092",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756013902",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086492",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436728402",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060201",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385097411",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436022403",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959081002",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999054015",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862020005",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060710",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004990",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008390",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806051110",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436728401",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959081090",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959081060",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029160",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407004905",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760086490",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049230",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081094",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224021960",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049260",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081260",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761401",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762424001",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919066030",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049272",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090107200",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081230",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049290",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060211",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761403",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505011405",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739090410",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187005690",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090210701",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756013904",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756013905",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008330",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782201",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919066072",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380073101",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629848801",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959081080",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761408",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187090930",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919066090",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854608",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877022410",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380073102",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380086906",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081290",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782203",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162010350",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739098410",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873803",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783801",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704208",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862020001",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187090990",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794101",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029184",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162010310",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881601",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794108",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782208",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029130",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629259310",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854606",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761406",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877022401",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881608",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847508",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783803",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783808",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380086907",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854609",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761409",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029190",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788950906",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854603",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794109",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854601",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877022405",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881606",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783809",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704201",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367013306",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873809",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847506",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788950903",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783806",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881609",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873801",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782206",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012205",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093090",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847509",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788950908",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847501",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093016304",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873806",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782209",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006472",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075780",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873808",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011801",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788950901",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061972",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881603",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794103",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021400",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075794",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097081507",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010092801",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097081512",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093030",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788950909",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794106",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021401",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162153401",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367013304",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006430",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006490",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093067",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010011805",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847503",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021406",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016303",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367034505",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093076",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205080890",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093078",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205048572",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010092805",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035102",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008004960",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012204",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021404",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021407",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021402",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205048590",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093000",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119905",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000501",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093016305",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021405",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035105",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335082001",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067172",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035101",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016660",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000502",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093064",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119903",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035108",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019853",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093055",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035104",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011360",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019892",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035100",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019880",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149601",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063153",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093060",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035107",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025427",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063180",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035103",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063160",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149604",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162214005",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093072",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149605",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018180",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189052430",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035106",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075753",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008203",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282032305",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021403",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016680",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035109",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075760",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021408",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016692",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149603",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189052460",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021409",
      "ndc_label_name": "Gabapentin CAPSULE 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019592",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019894",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025405",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335119902",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011390",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063192",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028601",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005960",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023412",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025490",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023430",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016694",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023460",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000503",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023490",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018160",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019560",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019860",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162214001",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011330",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011372",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189052490",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023424",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028602",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028603",
      "ndc_label_name": "Gabapentin Capsule 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383031147",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121406705",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121406740",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44523012016",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888010425",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42192060816",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722006947",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121106716",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033012305",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42192060845",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42192060805",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762505001",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033012344",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162069890",
      "ndc_label_name": "Gabapentin SOLUTION 250 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762505007",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82983042347",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162131804",
      "ndc_label_name": "Gabapentin Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440556260",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228263611",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556205",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228263650",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064705",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722016601",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556281",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063080",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556292",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556230",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756292",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556294",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063060",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087273",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556290",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090105300",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064701",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904682361",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571022601",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714033002",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063092",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253900",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556291",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685401",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571011601",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571022650",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087253",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087270",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080460",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685402",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714033001",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090726801",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571011650",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253901",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090105301",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999078401",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087280",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685500",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722016605",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771400",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063045",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090444501",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253902",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090444502",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090444500",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090708100",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080445",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228017701",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080492",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090708000",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685400",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228017705",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090708002",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090726802",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080480",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268035115",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087260",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032511",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090726900",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760074390",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771401",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436301101",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087230",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436012603",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087292",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436012601",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268035111",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056360",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771402",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436301103",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087245",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436042801",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090105302",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187005730",
      "ndc_label_name": "Gabapentin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436012602",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056390",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032515",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078963",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090708001",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224002150",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090726800",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187005760",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436301104",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000690",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078990",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289095960",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081530",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078960",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771500",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187014930",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224002160",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187005700",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919067790",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289095998",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081560",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289095930",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436301102",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629306302",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289095990",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629306303",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629306301",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760006660",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010372",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081590",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078912",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029230",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050701",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629306308",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629306306",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760098790",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919038730",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762435501",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078930",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094058960",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919038790",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629306309",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094058950",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029260",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056330",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050711",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919067730",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462012601",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756020201",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629849101",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462012605",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029290",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629306304",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760006690",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187014990",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788700503",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756020203",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629849201",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788700501",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382020405",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629306305",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056372",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629306307",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784008",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187005790",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877042805",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784006",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704909",
      "ndc_label_name": "Gabapentin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739056010",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078590",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629306310",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784709",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052301",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784706",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784009",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784703",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877042801",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380072701",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629730701",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848809",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788700506",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864101",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784708",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847601",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029291",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001041100",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629730702",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864106",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704901",
      "ndc_label_name": "Gabapentin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868703",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848803",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848808",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382020401",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788700508",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380072702",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367013404",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728809",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093190",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864103",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518235601",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704903",
      "ndc_label_name": "Gabapentin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784003",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052305",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205045730",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784001",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335270103",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864108",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093176",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704906",
      "ndc_label_name": "Gabapentin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784701",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001041103",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205053330",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847609",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006945",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864109",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101206",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848801",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010022701",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788700509",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093130",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868701",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006992",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868708",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335102604",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848806",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093100",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788704908",
      "ndc_label_name": "Gabapentin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101200",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367034605",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040030",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868709",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120003",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367013406",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093155",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847603",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101201",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010022705",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062153",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205053390",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120006",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335270101",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093178",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847606",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335128702",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093011104",
      "ndc_label_name": "Gabapentin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162214105",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093164",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335128704",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335270102",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101202",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847608",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335228101",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093011105",
      "ndc_label_name": "Gabapentin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189047130",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093167",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335306002",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004430",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101208",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868706",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004480",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101204",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023590",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335270106",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004453",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006960",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101209",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205045790",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062160",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335204801",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083612",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335306001",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040070",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040053",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120002",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093160",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062170",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335204806",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335204804",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004470",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610041060",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040073",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335204805",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093172",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077792",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335306003",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335306006",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004473",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046345",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046353",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004445",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120001",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71717010210",
      "ndc_label_name": "Gabapentin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335306004",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004460",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006980",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046360",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046392",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062180",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120004",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189047190",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004492",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076730",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076745",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046373",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062115",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076773",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335270104",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083605",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040045",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077760",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076753",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062145",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062130",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162153005",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040080",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009007105",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040060",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282040501",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076770",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062194",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076780",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023524",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046370",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804001590",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040092",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023560",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077745",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076792",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077773",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009701",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046380",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077753",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046330",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077780",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077770",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888013105",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031372",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282040590",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062173",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023530",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062192",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009704",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282040505",
      "ndc_label_name": "Gabapentin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020101",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189047160",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804021090",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162214101",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006330",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076760",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006390",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083601",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189047172",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031360",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077730",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771017705",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083690",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031390",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71717010250",
      "ndc_label_name": "Gabapentin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000101",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020102",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888013101",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162153001",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282070690",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619014501",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083660",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282070605",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020104",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619014502",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006360",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023512",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804019330",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083630",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804019390",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771017790",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000102",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009702",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009703",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020103",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804001530",
      "ndc_label_name": "Gabapentin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556360",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904710861",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228263750",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228263711",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556381",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556391",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556305",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571011701",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090128202",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064805",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756392",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064801",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556390",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353019045",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556330",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436728603",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032611",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571011750",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063061160",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722016701",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714033201",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740000",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556392",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700078090",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436429001",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722016705",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353019092",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353019053",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353019070",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268035213",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556394",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010460",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760051790",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353019060",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090618901",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090128201",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740001",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436721001",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714033202",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035060",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010490",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090128200",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090618902",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228017805",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436721003",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436721002",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999079901",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084330",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035090",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090618900",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436728602",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268032613",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436721004",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959077260",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228017801",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084390",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084360",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436728601",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224012160",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268035211",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959077230",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010430",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959077202",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187023190",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029360",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380072802",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959077290",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436728605",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700078060",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035030",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756020401",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052405",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382020505",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052401",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687051801",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224012150",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762446001",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756020403",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001060",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877042901",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788709801",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788709803",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760006760",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700078030",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629849001",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380072801",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777401",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029384",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788709806",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788709808",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760051730",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687051811",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877042905",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001041200",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367013506",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029391",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788710403",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788709809",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760051760",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001030",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382020501",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001041203",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016060",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462012705",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788710408",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775703",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035072",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001090",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777406",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094048950",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093230",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775701",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775706",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775709",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187023160",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629848901",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868801",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788710406",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335100701",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777403",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846808",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879009",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029390",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094048960",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868806",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788710409",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335305708",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777409",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010022805",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093011204",
      "ndc_label_name": "Gabapentin TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462012701",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788710401",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868808",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846801",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610042660",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879001",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205077460",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205051490",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775708",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846803",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879008",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868809",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044230",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367013504",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025403",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093260",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777408",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846806",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093264",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879003",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044280",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093200",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335276502",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093272",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868803",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846809",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093276",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879006",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063053",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093255",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335276503",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093290",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518232301",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010022801",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335203801",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367034705",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073760",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093278",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335276505",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025405",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025404",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016090",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335305704",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093011205",
      "ndc_label_name": "Gabapentin TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073780",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335203806",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044270",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335100703",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335100705",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205051460",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335305707",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016030",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073792",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335305703",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073730",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335203703",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335203705",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205077490",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043245",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205051430",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189009290",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335305706",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073753",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335203805",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335305702",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025402",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017830",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093267",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888013201",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335305709",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077870",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335305701",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335305705",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335203702",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039460",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335100702",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771017890",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043253",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162153101",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077853",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043792",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335276501",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039490",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335104101",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003501",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043270",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282040601",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189015890",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044245",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044292",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282070705",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063045",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015801",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063030",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282070790",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017872",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044253",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073745",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420049790",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063092",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000201",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063080",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420049724",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039430",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044260",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073773",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083705",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71717010310",
      "ndc_label_name": "Gabapentin TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044273",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162214201",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009007205",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282040690",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063060",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077845",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083790",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162153105",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063070",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039472",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804020330",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420049701",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063073",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061990",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015802",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162214205",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073770",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420049760",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020401",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420049712",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077892",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021760",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020404",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189015830",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71717010350",
      "ndc_label_name": "Gabapentin TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619014602",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619014601",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420049730",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189015872",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282040605",
      "ndc_label_name": "Gabapentin TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061972",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017890",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888013205",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804020360",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420049705",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083701",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083730",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003602",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020402",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420083760",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804020390",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771017805",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000202",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003601",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020403",
      "ndc_label_name": "Gabapentin Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629236501",
      "ndc_label_name": "Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162144703",
      "ndc_label_name": "Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591349730",
      "ndc_label_name": "Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335083683",
      "ndc_label_name": "Galantamine Hydrobromide ER CAPSULE EXTENDED RELEASE 24 HOUR 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353090505",
      "ndc_label_name": "Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10147089203",
      "ndc_label_name": "Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353098405",
      "ndc_label_name": "Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862074530",
      "ndc_label_name": "Galantamine Hydrobromide ER CAPSULE EXTENDED RELEASE 24 HOUR 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10147089303",
      "ndc_label_name": "Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 24 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162144803",
      "ndc_label_name": "Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 24 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629236301",
      "ndc_label_name": "Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 24 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335083783",
      "ndc_label_name": "Galantamine Hydrobromide ER CAPSULE EXTENDED RELEASE 24 HOUR 24 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591349830",
      "ndc_label_name": "Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 24 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862074630",
      "ndc_label_name": "Galantamine Hydrobromide ER CAPSULE EXTENDED RELEASE 24 HOUR 24 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10147089103",
      "ndc_label_name": "Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591349630",
      "ndc_label_name": "Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162144603",
      "ndc_label_name": "Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629236401",
      "ndc_label_name": "Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335083583",
      "ndc_label_name": "Galantamine Hydrobromide ER CAPSULE EXTENDED RELEASE 24 HOUR 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862074430",
      "ndc_label_name": "Galantamine Hydrobromide ER CAPSULE EXTENDED RELEASE 24 HOUR 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979072404",
      "ndc_label_name": "Galantamine Hydrobromide Tablet 12 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407090860",
      "ndc_label_name": "Galantamine Hydrobromide Tablet 12 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382017914",
      "ndc_label_name": "Galantamine Hydrobromide Tablet 12 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111040960",
      "ndc_label_name": "Galantamine Hydrobromide TABLET 12 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436000606",
      "ndc_label_name": "Galantamine Hydrobromide TABLET 12 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862046060",
      "ndc_label_name": "Galantamine Hydrobromide TABLET 12 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237005160",
      "ndc_label_name": "Galantamine Hydrobromide TABLET 12 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904710404",
      "ndc_label_name": "Galantamine Hydrobromide Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084072911",
      "ndc_label_name": "Galantamine Hydrobromide TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407090660",
      "ndc_label_name": "Galantamine Hydrobromide Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237004960",
      "ndc_label_name": "Galantamine Hydrobromide TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111040760",
      "ndc_label_name": "Galantamine Hydrobromide TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084072921",
      "ndc_label_name": "Galantamine Hydrobromide TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979072204",
      "ndc_label_name": "Galantamine Hydrobromide Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382017714",
      "ndc_label_name": "Galantamine Hydrobromide Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862045860",
      "ndc_label_name": "Galantamine Hydrobromide TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436000406",
      "ndc_label_name": "Galantamine Hydrobromide TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237005060",
      "ndc_label_name": "Galantamine Hydrobromide TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382017814",
      "ndc_label_name": "Galantamine Hydrobromide Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111040860",
      "ndc_label_name": "Galantamine Hydrobromide TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436000506",
      "ndc_label_name": "Galantamine Hydrobromide TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862045960",
      "ndc_label_name": "Galantamine Hydrobromide TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979072304",
      "ndc_label_name": "Galantamine Hydrobromide Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407090760",
      "ndc_label_name": "Galantamine Hydrobromide Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162256606",
      "ndc_label_name": "Galantamine Hydrobromide Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "41250088210",
      "ndc_label_name": "Gas Relief Infants Liquid 40 MG/0.6ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896079901",
      "ndc_label_name": "Gas Relief Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896079101",
      "ndc_label_name": "Gas Relief Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000043401",
      "ndc_label_name": "Gas Relief Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896079108",
      "ndc_label_name": "Gas Relief Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896079908",
      "ndc_label_name": "Gas Relief Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43386006019",
      "ndc_label_name": "GaviLyte-C Solution Reconstituted 240 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756092",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078406",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071460",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026005",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556005",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556092",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440556060",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026018",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078450",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806026005",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077253",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722012860",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026060",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806026060",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756060",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063074593",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722022501",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077280",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077260",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092160",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353009080",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090290200",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714010102",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999011430",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063074560",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090245002",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090580804",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090245000",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353076280",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090290202",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714010105",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999011460",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353009053",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090245003",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090723300",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090723304",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090290204",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016930",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722012805",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090245004",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090580803",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090580802",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090723303",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002106800",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090693900",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010760",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353009060",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090290203",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090691302",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090691303",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268035011",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049390",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090723400",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804022190",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353076260",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090691304",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919096860",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090723302",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687022401",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016360",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016305",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268035015",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090580800",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959093730",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862062405",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002106806",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077290",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687022411",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135016060",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644703",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090691300",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919096760",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788701106",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018605",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862062460",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020080",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077260",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018660",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090780900",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077230",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796406",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834013105",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267043630",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610060160",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097082112",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282022518",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762073705",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788701103",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934025590",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082430",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267043660",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934046660",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610060153",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082480",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919096730",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010780",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082453",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603020602",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796409",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603020601",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578006614",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834013160",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644706",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282022560",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834013118",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097082103",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796403",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010753",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934046630",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020060",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934046690",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082460",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162211906",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578006605",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018618",
      "ndc_label_name": "Gemfibrozil Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282022505",
      "ndc_label_name": "Gemfibrozil TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074310932",
      "ndc_label_name": "Gengraf CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074310832",
      "ndc_label_name": "Gengraf CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074726950",
      "ndc_label_name": "Gengraf Solution 100 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713068315",
      "ndc_label_name": "Gentamicin Sulfate CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739005565",
      "ndc_label_name": "Gentamicin Sulfate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802005611",
      "ndc_label_name": "Gentamicin Sulfate CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713068331",
      "ndc_label_name": "Gentamicin Sulfate CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802005635",
      "ndc_label_name": "Gentamicin Sulfate CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739005566",
      "ndc_label_name": "Gentamicin Sulfate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512003630",
      "ndc_label_name": "Gentamicin Sulfate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713068215",
      "ndc_label_name": "Gentamicin Sulfate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713068231",
      "ndc_label_name": "Gentamicin Sulfate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802004635",
      "ndc_label_name": "Gentamicin Sulfate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802004611",
      "ndc_label_name": "Gentamicin Sulfate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205056015",
      "ndc_label_name": "Gentamicin Sulfate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999013715",
      "ndc_label_name": "Gentamicin Sulfate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33358015635",
      "ndc_label_name": "Gentamicin Sulfate Ointment 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208058060",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436675201",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002092971",
      "ndc_label_name": "Gentamicin Sulfate SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959010301",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090056800",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478028310",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035905",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090056900",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090233300",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60758018805",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733605",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187076405",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919091805",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959010300",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025405",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267097105",
      "ndc_label_name": "Gentamicin Sulfate SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187056005",
      "ndc_label_name": "Gentamicin Sulfate SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61314063305",
      "ndc_label_name": "Gentamicin Sulfate SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267097015",
      "ndc_label_name": "Gentamicin Sulfate SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788859205",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205033305",
      "ndc_label_name": "Gentamicin Sulfate Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010605",
      "ndc_label_name": "Gentamicin Sulfate SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187016305",
      "ndc_label_name": "Gentamicin Sulfate SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49614013335",
      "ndc_label_name": "Gentle Laxative Suppository 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917016263",
      "ndc_label_name": "Gentle Laxative SUPPOSITORY 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917016232",
      "ndc_label_name": "Gentle Laxative SUPPOSITORY 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917016233",
      "ndc_label_name": "Gentle Laxative SUPPOSITORY 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363010908",
      "ndc_label_name": "Gentle Laxative SUPPOSITORY 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58980041504",
      "ndc_label_name": "Gentle Laxative SUPPOSITORY 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917011593",
      "ndc_label_name": "Gentle Laxative SUPPOSITORY 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58980041501",
      "ndc_label_name": "Gentle Laxative Suppository 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58980041550",
      "ndc_label_name": "Gentle Laxative Suppository 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58980041512",
      "ndc_label_name": "Gentle Laxative SUPPOSITORY 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917016262",
      "ndc_label_name": "Gentle Laxative SUPPOSITORY 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58980041516",
      "ndc_label_name": "Gentle Laxative Suppository 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000045101",
      "ndc_label_name": "Gentle Laxative Suppository 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000045102",
      "ndc_label_name": "Gentle Laxative Suppository 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917014449",
      "ndc_label_name": "Gentle Laxative SUPPOSITORY 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000057302",
      "ndc_label_name": "Gentle Laxative Suppository 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917021364",
      "ndc_label_name": "Gentle Laxative Suppository 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58980041508",
      "ndc_label_name": "Gentle Laxative SUPPOSITORY 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000057301",
      "ndc_label_name": "Gentle Laxative Suppository 10 MG Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090227900",
      "ndc_label_name": "Genvoya Tablet 150-150-200-10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958190101",
      "ndc_label_name": "Genvoya TABLET 150-150-200-10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58552014604",
      "ndc_label_name": "Giltuss EX Expectorant Child Liquid 200 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "47335099002",
      "ndc_label_name": "Glatiramer Acetate Solution Prefilled Syringe 20 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378696032",
      "ndc_label_name": "Glatiramer Acetate Solution Prefilled Syringe 20 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710154809",
      "ndc_label_name": "Glatiramer Acetate Solution Prefilled Syringe 20 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378696093",
      "ndc_label_name": "Glatiramer Acetate Solution Prefilled Syringe 20 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710154802",
      "ndc_label_name": "Glatiramer Acetate Solution Prefilled Syringe 20 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378696132",
      "ndc_label_name": "Glatiramer Acetate Solution Prefilled Syringe 40 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710154906",
      "ndc_label_name": "Glatiramer Acetate Solution Prefilled Syringe 40 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335099102",
      "ndc_label_name": "Glatiramer Acetate Solution Prefilled Syringe 40 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710154902",
      "ndc_label_name": "Glatiramer Acetate Solution Prefilled Syringe 40 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378696112",
      "ndc_label_name": "Glatiramer Acetate Solution Prefilled Syringe 40 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70147022216",
      "ndc_label_name": "Glenmax PEB Liquid 4-10 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "42571010005",
      "ndc_label_name": "Glimepiride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268035811",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000116",
      "ndc_label_name": "Glimepiride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077350",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440656401",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039410",
      "ndc_label_name": "Glimepiride TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000101",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077301",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069790",
      "ndc_label_name": "Glimepiride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111032001",
      "ndc_label_name": "Glimepiride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063012130",
      "ndc_label_name": "Glimepiride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571010001",
      "ndc_label_name": "Glimepiride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090639400",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090639402",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069793",
      "ndc_label_name": "Glimepiride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039450",
      "ndc_label_name": "Glimepiride TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442011505",
      "ndc_label_name": "Glimepiride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059490",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090718700",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063012190",
      "ndc_label_name": "Glimepiride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090709002",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090718701",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090354700",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090639401",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429091801",
      "ndc_label_name": "Glimepiride TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442011501",
      "ndc_label_name": "Glimepiride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001058400",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919072390",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012310",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111032005",
      "ndc_label_name": "Glimepiride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090709000",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090718702",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205077990",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012350",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001058403",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919072330",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090709001",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001017700",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084078825",
      "ndc_label_name": "Glimepiride TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001017703",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268035815",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921021450",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084078895",
      "ndc_label_name": "Glimepiride TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921021401",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014030",
      "ndc_label_name": "Glimepiride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039550",
      "ndc_label_name": "Glimepiride TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069830",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000201",
      "ndc_label_name": "Glimepiride TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440656501",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077401",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077450",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069890",
      "ndc_label_name": "Glimepiride TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071082330",
      "ndc_label_name": "Glimepiride TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090248601",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090248600",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090641504",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571010101",
      "ndc_label_name": "Glimepiride TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063094693",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000216",
      "ndc_label_name": "Glimepiride TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069893",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090641503",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090248604",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090248603",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642600",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458096716",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090152604",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571010105",
      "ndc_label_name": "Glimepiride TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999078100",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111032105",
      "ndc_label_name": "Glimepiride TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318903",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318900",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642603",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442011601",
      "ndc_label_name": "Glimepiride TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090762800",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039510",
      "ndc_label_name": "Glimepiride TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090152600",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001058500",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090641500",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318901",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090724600",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788769409",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111032101",
      "ndc_label_name": "Glimepiride TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090691000",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090152601",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809501",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642604",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318904",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090724601",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809506",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442011605",
      "ndc_label_name": "Glimepiride TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268035911",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090152603",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872801",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090724604",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090641501",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090724603",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012450",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919044830",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429091901",
      "ndc_label_name": "Glimepiride TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090724700",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804006590",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268035915",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642601",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001017803",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001058503",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919044860",
      "ndc_label_name": "Glimepiride TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809509",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919044890",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084032601",
      "ndc_label_name": "Glimepiride TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959093630",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934016730",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084032611",
      "ndc_label_name": "Glimepiride TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788769401",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645057290",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789037030",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788769403",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788769406",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959093660",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809503",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012410",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189048530",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001017800",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934072630",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872803",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921021550",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872806",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804006530",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872809",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934072690",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921021501",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189048560",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189048590",
      "ndc_label_name": "Glimepiride Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000301",
      "ndc_label_name": "Glimepiride TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198703",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039610",
      "ndc_label_name": "Glimepiride TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077501",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571010301",
      "ndc_label_name": "Glimepiride TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090100602",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000316",
      "ndc_label_name": "Glimepiride TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077550",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063058730",
      "ndc_label_name": "Glimepiride TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198704",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090248501",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571010305",
      "ndc_label_name": "Glimepiride TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039650",
      "ndc_label_name": "Glimepiride TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090248504",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069990",
      "ndc_label_name": "Glimepiride TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999080700",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063058790",
      "ndc_label_name": "Glimepiride TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090248503",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090248502",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090100600",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090100601",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740602",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090100604",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090100603",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069993",
      "ndc_label_name": "Glimepiride TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317200",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090632204",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198700",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317203",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111032201",
      "ndc_label_name": "Glimepiride TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198701",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090248500",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317201",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090632202",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268036011",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317202",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655012052",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025030",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198702",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090632200",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317204",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740601",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429092001",
      "ndc_label_name": "Glimepiride TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740600",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760080090",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001058603",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685200",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090632203",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090632201",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740604",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760024890",
      "ndc_label_name": "Glimepiride TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090782300",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442011705",
      "ndc_label_name": "Glimepiride TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645057390",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740603",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268036015",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740700",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458096616",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442011701",
      "ndc_label_name": "Glimepiride TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025082",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025004",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084032701",
      "ndc_label_name": "Glimepiride TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025090",
      "ndc_label_name": "Glimepiride TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111032205",
      "ndc_label_name": "Glimepiride TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088800",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084032711",
      "ndc_label_name": "Glimepiride TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919025060",
      "ndc_label_name": "Glimepiride TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012510",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771003",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843203",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001017903",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760084590",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088830",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023660",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001017900",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771006",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023680",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934072730",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771009",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189045390",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760023090",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921021601",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189058590",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921021650",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001058600",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071038830",
      "ndc_label_name": "Glimepiride TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843206",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843209",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543012550",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934032330",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934032390",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205077330",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004830",
      "ndc_label_name": "Glimepiride Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591084510",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090676502",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591084501",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714089602",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756990",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756992",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370074601",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090291501",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370074605",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090162600",
      "ndc_label_name": "GlipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714089601",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090580602",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090676500",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919071530",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090291502",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090676501",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090580600",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629220201",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090291500",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289030193",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980028101",
      "ndc_label_name": "GlipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084011211",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651078205",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651078201",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090580601",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382033701",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289030190",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651027005",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785601",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760079390",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760056890",
      "ndc_label_name": "GlipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919072590",
      "ndc_label_name": "GlipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090684900",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084011201",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629220301",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788723001",
      "ndc_label_name": "GlipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651027001",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785606",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788723003",
      "ndc_label_name": "GlipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919071590",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980028105",
      "ndc_label_name": "GlipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382033705",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788723006",
      "ndc_label_name": "GlipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980028110",
      "ndc_label_name": "GlipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788723009",
      "ndc_label_name": "GlipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785603",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785609",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651078030",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189007090",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714089401",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591090030",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687048021",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980027903",
      "ndc_label_name": "GlipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999051430",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382033506",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687076811",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848703",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651026830",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848706",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919085090",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848709",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848701",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687048011",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687076821",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370074501",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306900",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756892",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756890",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10370074505",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090504000",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714089502",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591084401",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919071330",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651078101",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591084410",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306902",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090429700",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651026905",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090085200",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714089501",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084011111",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980028001",
      "ndc_label_name": "GlipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629220401",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090429702",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629928101",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687088101",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090085202",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090504002",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382033605",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687088111",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629220501",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760016530",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980028010",
      "ndc_label_name": "GlipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919071390",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674602",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674600",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980028005",
      "ndc_label_name": "GlipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335038802",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289077930",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760032930",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651026901",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289077990",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760074530",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651078105",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071000830",
      "ndc_label_name": "GlipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760079430",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084011101",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382033601",
      "ndc_label_name": "glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756630",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378111001",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756690",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756692",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086160",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378111005",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090719700",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086193",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591046110",
      "ndc_label_name": "GlipiZIDE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756691",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086114",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591046105",
      "ndc_label_name": "GlipiZIDE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086190",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756660",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773402",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050301",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353036953",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353036970",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086198",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353036992",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740500",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591046101",
      "ndc_label_name": "GlipiZIDE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773405",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050306",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353036960",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050302",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999010760",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353036994",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773401",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014000",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773500",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207505",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353036980",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207502",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050501",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999010790",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268036211",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014016",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268036215",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090699600",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050305",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740400",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050502",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050300",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012992",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291043010",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081190",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079081101",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207501",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740401",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207500",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050500",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012994",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086130",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099330",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959082230",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207504",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959082200",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207506",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050505",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788401703",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740405",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788401706",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118046109",
      "ndc_label_name": "GlipiZIDE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740406",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700058530",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740402",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050506",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934030030",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773400",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406103",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505014202",
      "ndc_label_name": "GlipiZIDE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959082260",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028730",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079081120",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655081025",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335061802",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773406",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406106",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687070111",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505014204",
      "ndc_label_name": "GlipiZIDE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559031610",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002111100",
      "ndc_label_name": "GlipiZIDE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081130",
      "ndc_label_name": "GlipiZIDE TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335061807",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407062110",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819201",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099360",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028760",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267009930",
      "ndc_label_name": "GlipiZIDE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002111103",
      "ndc_label_name": "GlipiZIDE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813801",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010553",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687070101",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819206",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645057559",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012953",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012930",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002111106",
      "ndc_label_name": "GlipiZIDE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813803",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011700",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099390",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162221500",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819203",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012960",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788401701",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700058590",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934030090",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096030",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012980",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043702",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819208",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012970",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406101",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505014200",
      "ndc_label_name": "GlipiZIDE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335061805",
      "ndc_label_name": "GlipiZIDE TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788401709",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406108",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425054901",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788819209",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406109",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813806",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505014201",
      "ndc_label_name": "GlipiZIDE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010570",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813808",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335254005",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096011",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010592",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584031050",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813809",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028782",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010580",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010560",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010594",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096060",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039360",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066870",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584031090",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584031010",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039380",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066894",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066880",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096072",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066892",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046390",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335061801",
      "ndc_label_name": "GlipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039370",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039394",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046393",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162210200",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096090",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046386",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051030",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039353",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039392",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066853",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425054902",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011705",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066860",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043703",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046395",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011701",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043701",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425054903",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096000",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096055",
      "ndc_label_name": "glipiZIDE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378110505",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756530",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591046010",
      "ndc_label_name": "GlipiZIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378110501",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756590",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756514",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904663761",
      "ndc_label_name": "GlipiZIDE TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013916",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037980",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353020745",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207603",
      "ndc_label_name": "GlipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440756560",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591046001",
      "ndc_label_name": "GlipiZIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591046005",
      "ndc_label_name": "GlipiZIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353020760",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291042910",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505014100",
      "ndc_label_name": "GlipiZIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037909",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090647301",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050202",
      "ndc_label_name": "GlipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353020794",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013900",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353020780",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207600",
      "ndc_label_name": "GlipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687069001",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037992",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090775500",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090775501",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037973",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050201",
      "ndc_label_name": "GlipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037945",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207602",
      "ndc_label_name": "GlipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402008",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050200",
      "ndc_label_name": "GlipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090775503",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268036111",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207601",
      "ndc_label_name": "GlipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090647300",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037960",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740202",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851203",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050203",
      "ndc_label_name": "GlipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687069011",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002044630",
      "ndc_label_name": "GlipiZIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207604",
      "ndc_label_name": "GlipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740300",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037998",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090775504",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004160",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090647304",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824306",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002044660",
      "ndc_label_name": "GlipiZIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090647302",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090775502",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050204",
      "ndc_label_name": "GlipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090775600",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335003601",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740203",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855001",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289080660",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740201",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268036115",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090647303",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959082360",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017560",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959082320",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855008",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289080690",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407062010",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289080693",
      "ndc_label_name": "GlipiZIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090697500",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002044600",
      "ndc_label_name": "GlipiZIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038880",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289080686",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934066630",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505014101",
      "ndc_label_name": "GlipiZIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655018026",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700062490",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740200",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289080630",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068098",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505014102",
      "ndc_label_name": "GlipiZIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335003605",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028690",
      "ndc_label_name": "GlipiZIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559031510",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919072230",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740204",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919047630",
      "ndc_label_name": "GlipiZIDE TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046486",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402001",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038898",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645057454",
      "ndc_label_name": "GlipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824303",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788014103",
      "ndc_label_name": "GlipiZIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289080614",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824308",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046490",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824301",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068060",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402009",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824309",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402003",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700062430",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851208",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046495",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851201",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804017490",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855003",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851209",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402006",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505014108",
      "ndc_label_name": "GlipiZIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004130",
      "ndc_label_name": "GlipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011601",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584030950",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095955",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009830",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855006",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584030910",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851206",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017573",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855009",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017592",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335003602",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009890",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004178",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584030990",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335003603",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013030",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017545",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017598",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017594",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004190",
      "ndc_label_name": "GlipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038860",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017580",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038892",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095911",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068092",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068045",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011600",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335003604",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162210300",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038845",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095990",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068073",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335003606",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038873",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013090",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068080",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095930",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046493",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011605",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804017430",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095900",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095960",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095972",
      "ndc_label_name": "glipiZIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00169706515",
      "ndc_label_name": "GlucaGen HypoKit Solution Reconstituted 1 MG Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002803101",
      "ndc_label_name": "Glucagon Emergency Kit 1 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378806790",
      "ndc_label_name": "Glucagon Emergency Solution Reconstituted 1 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70748031101",
      "ndc_label_name": "Glucagon Emergency Solution Reconstituted 1 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002803101",
      "ndc_label_name": "Glucagon Emergency Solution Reconstituted 1 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090063900",
      "ndc_label_name": "Glucagon Emergency Solution Reconstituted 1 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090655000",
      "ndc_label_name": "Glucagon Emergency Solution Reconstituted 1 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00548585000",
      "ndc_label_name": "Glucagon Emergency Solution Reconstituted 1 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097002750",
      "ndc_label_name": "Glucagon Emergency Solution Reconstituted 1 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "38396091618",
      "ndc_label_name": "Glucose Instant Energy Tablet Chewable 4-6 GM-MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629339703",
      "ndc_label_name": "glyBURIDE Micronized Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093803401",
      "ndc_label_name": "glyBURIDE Micronized Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999080800",
      "ndc_label_name": "glyBURIDE Micronized Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093803501",
      "ndc_label_name": "glyBURIDE Micronized Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093803505",
      "ndc_label_name": "glyBURIDE Micronized Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093803601",
      "ndc_label_name": "glyBURIDE Micronized Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999057160",
      "ndc_label_name": "glyBURIDE Micronized Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155005601",
      "ndc_label_name": "GlyBURIDE TABLET 1.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093947753",
      "ndc_label_name": "GlyBURIDE TABLET 1.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834020201",
      "ndc_label_name": "glyBURIDE Tablet 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093834201",
      "ndc_label_name": "GlyBURIDE TABLET 1.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105098411",
      "ndc_label_name": "GlyBURIDE TABLET 1.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105098410",
      "ndc_label_name": "GlyBURIDE TABLET 1.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959059890",
      "ndc_label_name": "glyBURIDE Tablet 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135058330",
      "ndc_label_name": "glyBURIDE Tablet 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121092990",
      "ndc_label_name": "GlyBURIDE Tablet 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105098406",
      "ndc_label_name": "GlyBURIDE TABLET 1.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105098403",
      "ndc_label_name": "GlyBURIDE TABLET 1.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065601",
      "ndc_label_name": "GlyBURIDE Tablet 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105098450",
      "ndc_label_name": "GlyBURIDE TABLET 1.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241003805",
      "ndc_label_name": "GlyBURIDE Tablet 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093943305",
      "ndc_label_name": "glyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121093090",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093834398",
      "ndc_label_name": "GlyBURIDE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093834301",
      "ndc_label_name": "GlyBURIDE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353065980",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093834305",
      "ndc_label_name": "GlyBURIDE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093834310",
      "ndc_label_name": "GlyBURIDE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090577602",
      "ndc_label_name": "glyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291031650",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090049400",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058260",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093943301",
      "ndc_label_name": "GlyBURIDE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090049402",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155005701",
      "ndc_label_name": "GlyBURIDE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440757020",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740802",
      "ndc_label_name": "glyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919033030",
      "ndc_label_name": "GlyBURIDE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629290702",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058280",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629290703",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090740800",
      "ndc_label_name": "glyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629290701",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090577600",
      "ndc_label_name": "glyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187084830",
      "ndc_label_name": "GlyBURIDE TABLET 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105098550",
      "ndc_label_name": "GlyBURIDE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105098506",
      "ndc_label_name": "GlyBURIDE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353065960",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241003910",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135058430",
      "ndc_label_name": "glyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105098510",
      "ndc_label_name": "GlyBURIDE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289060630",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105098503",
      "ndc_label_name": "GlyBURIDE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071414203",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071414206",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289060690",
      "ndc_label_name": "GlyBURIDE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071414209",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065701",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241003911",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105098511",
      "ndc_label_name": "GlyBURIDE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919033060",
      "ndc_label_name": "GlyBURIDE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241003905",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065705",
      "ndc_label_name": "GlyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834020301",
      "ndc_label_name": "glyBURIDE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440757194",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093936410",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093834498",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440757195",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440757160",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440757114",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093834405",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093834401",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063043314",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353065690",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063043393",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063043386",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440757190",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440757191",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093834410",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093936405",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353065653",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090049509",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090049500",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063043390",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155005801",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063043330",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093936401",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121093190",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353065670",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090342909",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090049601",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090049600",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155005810",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353065660",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121093192",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291031710",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353065692",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090619600",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090619601",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090342901",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090049602",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353065680",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440757130",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090301209",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090049501",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044901",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090619602",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090619608",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090049608",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353065694",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440757192",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090785900",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090049502",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105098610",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044960",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629139302",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090660700",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090049609",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063043360",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348010430",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090049508",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105098611",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135058590",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407303",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629139304",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090619609",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037890",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700072590",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241004005",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105098650",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629139301",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241004010",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105098603",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044930",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267010330",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065801",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241004011",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788850803",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407301",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804015000",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105098606",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037860",
      "ndc_label_name": "GlyBURIDE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797003",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834309",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407306",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788850806",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797009",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629139303",
      "ndc_label_name": "GlyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834020400",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788850809",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788850801",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065810",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834303",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934071590",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834020401",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407309",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804015030",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797001",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797006",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834301",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834306",
      "ndc_label_name": "glyBURIDE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228275111",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 1.25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862008001",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 1.25-250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155023301",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 1.25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440758590",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 1.25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065301",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 1.25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237002301",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 1.25-250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111069501",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 1.25-250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862008005",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 1.25-250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237002305",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 1.25-250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090781400",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090203102",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440758790",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718001",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090088700",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237002405",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 2.5-500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155023401",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228275211",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862008101",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 2.5-500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268035611",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090088702",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228275250",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268035615",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862008105",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 2.5-500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065405",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090781402",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718006",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718009",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090203100",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065401",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111069601",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718003",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111069610",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237002401",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 2.5-500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228275350",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440758990",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090203000",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090088802",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155023501",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268035715",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090088803",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228275311",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090203003",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440758995",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862008201",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 5-500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090751402",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090088801",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111069701",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090751400",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090203002",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863401",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090088800",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834101",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090751404",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090088804",
      "ndc_label_name": "GlyBURIDE-MetFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919041860",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 5-500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090751403",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111069710",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879101",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237002505",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 5-500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834106",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268035711",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090203004",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788691506",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788691503",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862008205",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 5-500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879106",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071002860",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 5-500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863406",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065501",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237002501",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 5-500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834103",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788691508",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071002830",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 5-500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065505",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788691509",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863409",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863408",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788691501",
      "ndc_label_name": "GlyBURIDE-MetFORMIN TABLET 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834108",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863403",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879103",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879109",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834109",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879108",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335250801",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027501",
      "ndc_label_name": "glyBURIDE-metFORMIN Tablet 5-500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237032552",
      "ndc_label_name": "Glycerin (Adult) Suppository 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011516",
      "ndc_label_name": "Glycerin (Adult) SUPPOSITORY 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917019062",
      "ndc_label_name": "Glycerin (Adult) SUPPOSITORY 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00132007524",
      "ndc_label_name": "Glycerin (Adult) Suppository 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70166031125",
      "ndc_label_name": "Glycerin (Adult) Suppository 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00132007900",
      "ndc_label_name": "Glycerin (Adult) Suppository 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00132007912",
      "ndc_label_name": "Glycerin (Adult) Suppository 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00132007512",
      "ndc_label_name": "Glycerin (Adult) Suppository 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "84415004102",
      "ndc_label_name": "Glycerin (Adult) Suppository 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57237032521",
      "ndc_label_name": "Glycerin (Adult) Suppository 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00132007550",
      "ndc_label_name": "Glycerin (Adult) Suppository 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917014447",
      "ndc_label_name": "Glycerin (Adult) SUPPOSITORY 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00132007924",
      "ndc_label_name": "Glycerin (Adult) Suppository 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58980041012",
      "ndc_label_name": "Glycerin (Adult) SUPPOSITORY 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00132007950",
      "ndc_label_name": "Glycerin (Adult) Suppository 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58980041025",
      "ndc_label_name": "Glycerin (Adult) SUPPOSITORY 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58980041050",
      "ndc_label_name": "Glycerin (Adult) SUPPOSITORY 2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013297",
      "ndc_label_name": "Glycerin (Adult) SUPPOSITORY 2.1 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013298",
      "ndc_label_name": "Glycerin (Adult) SUPPOSITORY 2.1 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917001008",
      "ndc_label_name": "Glycerin (Adult) SUPPOSITORY 2.1 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917001009",
      "ndc_label_name": "Glycerin (Adult) SUPPOSITORY 2.1 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917001006",
      "ndc_label_name": "Glycerin (Adult) SUPPOSITORY 2.1 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917016264",
      "ndc_label_name": "Glycerin (Adult) SUPPOSITORY 2.1 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917001005",
      "ndc_label_name": "Glycerin (Pediatric) SUPPOSITORY 1.2 GM Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49884004233",
      "ndc_label_name": "Glycopyrrolate Solution 1 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00259050216",
      "ndc_label_name": "Glycopyrrolate Solution 1 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651043547",
      "ndc_label_name": "Glycopyrrolate Solution 1 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71656006116",
      "ndc_label_name": "Glycopyrrolate Solution 1 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672531609",
      "ndc_label_name": "Glycopyrrolate Solution 1 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135096147",
      "ndc_label_name": "Glycopyrrolate Solution 1 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629959201",
      "ndc_label_name": "Glycopyrrolate Solution 1 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722001647",
      "ndc_label_name": "Glycopyrrolate Solution 1 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094007358",
      "ndc_label_name": "Glycopyrrolate Solution 1 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094007301",
      "ndc_label_name": "Glycopyrrolate Solution 1 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205007072",
      "ndc_label_name": "Glycopyrrolate Solution 1 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603024001",
      "ndc_label_name": "Glycopyrrolate Solution 1 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107001401",
      "ndc_label_name": "Glycopyrrolate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629928701",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884006501",
      "ndc_label_name": "Glycopyrrolate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904670961",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571074309",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291030390",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268036311",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118006501",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155060601",
      "ndc_label_name": "Glycopyrrolate TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788827906",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429066501",
      "ndc_label_name": "Glycopyrrolate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268036315",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111064801",
      "ndc_label_name": "Glycopyrrolate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980027201",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135073460",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69076047501",
      "ndc_label_name": "Glycopyrrolate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64125013901",
      "ndc_label_name": "Glycopyrrolate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788865003",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788827903",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980025801",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687045801",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921011001",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629220601",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70752010810",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687045811",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788827909",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788865009",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788865006",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315013901",
      "ndc_label_name": "Glycopyrrolate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162147701",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162259701",
      "ndc_label_name": "Glycopyrrolate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980025901",
      "ndc_label_name": "Glycopyrrolate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69076047601",
      "ndc_label_name": "Glycopyrrolate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111064901",
      "ndc_label_name": "Glycopyrrolate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571074409",
      "ndc_label_name": "Glycopyrrolate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107001501",
      "ndc_label_name": "Glycopyrrolate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884006601",
      "ndc_label_name": "Glycopyrrolate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429066601",
      "ndc_label_name": "Glycopyrrolate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155060701",
      "ndc_label_name": "Glycopyrrolate TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291030490",
      "ndc_label_name": "Glycopyrrolate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162147801",
      "ndc_label_name": "Glycopyrrolate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135073560",
      "ndc_label_name": "Glycopyrrolate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64125014001",
      "ndc_label_name": "Glycopyrrolate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70752010910",
      "ndc_label_name": "Glycopyrrolate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980027301",
      "ndc_label_name": "Glycopyrrolate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629220701",
      "ndc_label_name": "Glycopyrrolate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921011101",
      "ndc_label_name": "Glycopyrrolate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315014001",
      "ndc_label_name": "Glycopyrrolate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162259801",
      "ndc_label_name": "Glycopyrrolate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021067377",
      "ndc_label_name": "Glydo Prefilled Syringe 2 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021067376",
      "ndc_label_name": "Glydo Prefilled Syringe 2 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00113135278",
      "ndc_label_name": "GoodSense Nicotine Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113810025",
      "ndc_label_name": "GoodSense Nicotine Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113002971",
      "ndc_label_name": "GoodSense Nicotine Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113045660",
      "ndc_label_name": "GoodSense Nicotine Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113002925",
      "ndc_label_name": "GoodSense Nicotine Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090706300",
      "ndc_label_name": "GoodSense Nicotine Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113002960",
      "ndc_label_name": "GoodSense Nicotine Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "42043039000",
      "ndc_label_name": "Granisetron HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043039040",
      "ndc_label_name": "Granisetron HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043039020",
      "ndc_label_name": "Granisetron HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043039021",
      "ndc_label_name": "Granisetron HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452035001",
      "ndc_label_name": "Granisetron HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991073599",
      "ndc_label_name": "Granisetron HCl TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991073532",
      "ndc_label_name": "Granisetron HCl TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043039002",
      "ndc_label_name": "Granisetron HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452035060",
      "ndc_label_name": "Granisetron HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991073520",
      "ndc_label_name": "Granisetron HCl TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452035092",
      "ndc_label_name": "Granisetron HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452035011",
      "ndc_label_name": "Granisetron HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713085004",
      "ndc_label_name": "Griseofulvin Microsize Suspension 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097036108",
      "ndc_label_name": "Griseofulvin Microsize SUSPENSION 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135096841",
      "ndc_label_name": "Griseofulvin Microsize Suspension 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472001304",
      "ndc_label_name": "Griseofulvin Microsize SUSPENSION 125 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54162001512",
      "ndc_label_name": "GRx HiCort 25 SUPPOSITORY 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121080904",
      "ndc_label_name": "Guaifenesin DM Cough & Chest LIQUID† 10-200 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536116361",
      "ndc_label_name": "guaiFENesin ER Tablet Extended Release 12 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70010019905",
      "ndc_label_name": "guaiFENesin ER Tablet Extended Release 12 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660007021",
      "ndc_label_name": "guaiFENesin ER Tablet Extended Release 12 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71610049953",
      "ndc_label_name": "guaiFENesin ER Tablet Extended Release 12 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660056621",
      "ndc_label_name": "guaiFENesin ER Tablet Extended Release 12 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71610049912",
      "ndc_label_name": "guaiFENesin ER Tablet Extended Release 12 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58602081097",
      "ndc_label_name": "guaiFENesin ER Tablet Extended Release 12 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001056116",
      "ndc_label_name": "guaiFENesin ER Tablet Extended Release 12 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001056117",
      "ndc_label_name": "guaiFENesin ER Tablet Extended Release 12 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094004859",
      "ndc_label_name": "guaiFENesin ER Tablet Extended Release 12 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094004861",
      "ndc_label_name": "guaiFENesin ER Tablet Extended Release 12 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121148800",
      "ndc_label_name": "GuaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121148810",
      "ndc_label_name": "GuaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033010205",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58657050916",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72162227802",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121174400",
      "ndc_label_name": "GuaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090271100",
      "ndc_label_name": "GuaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54569438100",
      "ndc_label_name": "GuaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50436109501",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121223200",
      "ndc_label_name": "GuaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58657050816",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54569547400",
      "ndc_label_name": "GuaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83720050316",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121174405",
      "ndc_label_name": "GuaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033010252",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60687085217",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033010216",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52959085104",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033010210",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121223215",
      "ndc_label_name": "GuaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033010215",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629115601",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033010251",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60687085240",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72162167102",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71800005919",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033010253",
      "ndc_label_name": "guaiFENesin Liquid 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090271100",
      "ndc_label_name": "GuaiFENesin Syrup 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610043418",
      "ndc_label_name": "GuaiFENesin Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440757391",
      "ndc_label_name": "GuaiFENesin Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135078901",
      "ndc_label_name": "guaiFENesin Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440757320",
      "ndc_label_name": "GuaiFENesin Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54738098001",
      "ndc_label_name": "GuaiFENesin Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440757306",
      "ndc_label_name": "GuaiFENesin Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135068101",
      "ndc_label_name": "GuaiFENesin Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904515460",
      "ndc_label_name": "GuaiFENesin TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610009818",
      "ndc_label_name": "GuaiFENesin Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50436252001",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162166902",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54932020885",
      "ndc_label_name": "Guaifenesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121077508",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788836101",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121077504",
      "ndc_label_name": "Guaifenesin-Codeine SOLUTION 100-10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121177500",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090643500",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69367027204",
      "ndc_label_name": "Guaifenesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121177505",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68071135004",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121077516",
      "ndc_label_name": "Guaifenesin-Codeine SOLUTION 100-10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69315024812",
      "ndc_label_name": "Guaifenesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "17856027301",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "17856050005",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54932020881",
      "ndc_label_name": "Guaifenesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189041104",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121177540",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090142800",
      "ndc_label_name": "Guaifenesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58657050004",
      "ndc_label_name": "Guaifenesin-Codeine SOLUTION 100-10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189033704",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788792101",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788723501",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58657050016",
      "ndc_label_name": "Guaifenesin-Codeine SOLUTION 100-10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69367027216",
      "ndc_label_name": "Guaifenesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70752018012",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70752018006",
      "ndc_label_name": "guaiFENesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69315024848",
      "ndc_label_name": "Guaifenesin-Codeine Solution 100-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121155000",
      "ndc_label_name": "guaiFENesin-Codeine Solution 200-20 MG/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121155040",
      "ndc_label_name": "guaiFENesin-Codeine Solution 200-20 MG/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121155010",
      "ndc_label_name": "guaiFENesin-Codeine Solution 200-20 MG/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51407095201",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979053301",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714019001",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300046001",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429096001",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228285011",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505392701",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291032401",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436003901",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094460",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162210401",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760086330",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094490",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162179801",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094400",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304092401",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094455",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189059730",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72266025555",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332074531",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888022401",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094430",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189046930",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407095301",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291032501",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228285111",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979053401",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436004001",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505392801",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714019101",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300046101",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429096101",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094530",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335285201",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094560",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094500",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094590",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162210501",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332074631",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094555",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888022501",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72266025655",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304092501",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090649300",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228285311",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291032601",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304092601",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094630",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090764400",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979053601",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090599100",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436004101",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714019201",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429096201",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505392901",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094690",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332074731",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300046201",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094655",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094660",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888022601",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162202903",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090712900",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72266025755",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407095401",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094600",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162202901",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332074831",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094790",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300046301",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228285511",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304092701",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714019301",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429096301",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407095501",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162203003",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335300501",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094760",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291032701",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629110501",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979053801",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162203001",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094755",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888022701",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505393001",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436004201",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094700",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72266025855",
      "ndc_label_name": "guanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205094730",
      "ndc_label_name": "GuanFACINE HCl ER Tablet Extended Release 24 Hour 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591044401",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806004801",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658073001",
      "ndc_label_name": "GuanFACINE HCl TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356016130",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241024201",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979019801",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094001959",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356016190",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904714004",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746071101",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959094500",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090411900",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687071011",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687071021",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094001962",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291031001",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300045801",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651084001",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094006559",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135072790",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72319001804",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162071110",
      "ndc_label_name": "GuanFACINE HCl TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094006562",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291031090",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090607300",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888012301",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700030101",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73141001804",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603026801",
      "ndc_label_name": "guanFACINE HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651084101",
      "ndc_label_name": "guanFACINE HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591045301",
      "ndc_label_name": "guanFACINE HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746071301",
      "ndc_label_name": "guanFACINE HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658073101",
      "ndc_label_name": "guanFACINE HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268037411",
      "ndc_label_name": "GuanFACINE HCl TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979019901",
      "ndc_label_name": "guanFACINE HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72319001904",
      "ndc_label_name": "guanFACINE HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603026901",
      "ndc_label_name": "guanFACINE HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888012401",
      "ndc_label_name": "guanFACINE HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806029601",
      "ndc_label_name": "guanFACINE HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241024301",
      "ndc_label_name": "guanFACINE HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700030201",
      "ndc_label_name": "guanFACINE HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300045901",
      "ndc_label_name": "guanFACINE HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162071310",
      "ndc_label_name": "GuanFACINE HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268037415",
      "ndc_label_name": "GuanFACINE HCl TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135072890",
      "ndc_label_name": "guanFACINE HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73141001904",
      "ndc_label_name": "guanFACINE HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72065012011",
      "ndc_label_name": "Gvoke HypoPen 1-Pack Solution Auto-Injector 0.5 MG/0.1ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72065012111",
      "ndc_label_name": "Gvoke HypoPen 1-Pack Solution Auto-Injector 1 MG/0.2ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72065014111",
      "ndc_label_name": "Gvoke Kit Solution 1 MG/0.2ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72065014011",
      "ndc_label_name": "Gvoke Kit Solution 1 MG/0.2ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72065013011",
      "ndc_label_name": "Gvoke PFS Solution Prefilled Syringe 0.5 MG/0.1ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72065013012",
      "ndc_label_name": "Gvoke PFS Solution Prefilled Syringe 0.5 MG/0.1ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72065013112",
      "ndc_label_name": "Gvoke PFS Solution Prefilled Syringe 1 MG/0.2ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72065013111",
      "ndc_label_name": "Gvoke PFS Solution Prefilled Syringe 1 MG/0.2ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "78206018701",
      "ndc_label_name": "Hadlima PushTouch Solution Auto-Injector 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "78206018401",
      "ndc_label_name": "Hadlima PushTouch Solution Auto-Injector 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "78206018601",
      "ndc_label_name": "Hadlima Solution Prefilled Syringe 40 MG/0.4ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "78206018301",
      "ndc_label_name": "Hadlima Solution Prefilled Syringe 40 MG/0.8ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629873501",
      "ndc_label_name": "Halobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672132101",
      "ndc_label_name": "Halobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168035550",
      "ndc_label_name": "Halobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802012935",
      "ndc_label_name": "Halobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168035515",
      "ndc_label_name": "Halobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713064015",
      "ndc_label_name": "Halobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713064086",
      "ndc_label_name": "Halobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162233102",
      "ndc_label_name": "Halobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672132103",
      "ndc_label_name": "Halobetasol Propionate Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802012932",
      "ndc_label_name": "Halobetasol Propionate CREAM 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713033986",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672132203",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356024515",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713033915",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713075815",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206702",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672132201",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802013132",
      "ndc_label_name": "Halobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713075886",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752011902",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959096150",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629866501",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752011904",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802013135",
      "ndc_label_name": "Halobetasol Propionate OINTMENT 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739099867",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629866401",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162206704",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162139602",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512003350",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162225802",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162139604",
      "ndc_label_name": "Halobetasol Propionate Ointment 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00703713101",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145016710",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10147092205",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143929501",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021083405",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047155",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710146405",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143929601",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047141",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457038100",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047105",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703713301",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047101",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457040913",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069038405",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703713103",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047151",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457038158",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710146301",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145016701",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145016901",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001058241",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756061681",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021083301",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001058182",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457040900",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288050301",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001057948",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069038301",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069003105",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001065841",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001058141",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069038310",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069038305",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001065941",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001057959",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069086701",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710146305",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069003101",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001065852",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756061610",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069086801",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001058148",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288050302",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069086705",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288050405",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069038401",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603023001",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710146401",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069086710",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756062585",
      "ndc_label_name": "Haloperidol Decanoate Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703712103",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046905",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457041013",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069003003",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046951",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001057848",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703712101",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145016810",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703712301",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001057859",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710146106",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069086601",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288050202",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001065756",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021083101",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457041000",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10147092103",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069038101",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710146201",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069038110",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323046901",
      "ndc_label_name": "Haloperidol Decanoate SOLUTION 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069003001",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001065751",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756061510",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145016801",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069086610",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756062485",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710146109",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68001058041",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288050201",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710146101",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756061581",
      "ndc_label_name": "Haloperidol Decanoate Solution 50 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121058115",
      "ndc_label_name": "Haloperidol Lactate Concentrate 2 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121058104",
      "ndc_label_name": "Haloperidol Lactate CONCENTRATE 2 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904711270",
      "ndc_label_name": "Haloperidol Lactate Concentrate 2 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54838050140",
      "ndc_label_name": "Haloperidol Lactate CONCENTRATE 2 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54838050115",
      "ndc_label_name": "Haloperidol Lactate CONCENTRATE 2 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904711241",
      "ndc_label_name": "Haloperidol Lactate Concentrate 2 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888017348",
      "ndc_label_name": "Haloperidol Lactate Concentrate 2 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888017347",
      "ndc_label_name": "Haloperidol Lactate Concentrate 2 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121058105",
      "ndc_label_name": "Haloperidol Lactate CONCENTRATE 2 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047400",
      "ndc_label_name": "Haloperidol Lactate Solution 5 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143931925",
      "ndc_label_name": "Haloperidol Lactate Solution 5 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518003500",
      "ndc_label_name": "Haloperidol Lactate Solution 5 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143931901",
      "ndc_label_name": "Haloperidol Lactate Solution 5 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950125",
      "ndc_label_name": "Haloperidol Lactate SOLUTION 5 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950201",
      "ndc_label_name": "Haloperidol Lactate SOLUTION 5 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021080601",
      "ndc_label_name": "Haloperidol Lactate SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143950101",
      "ndc_label_name": "Haloperidol Lactate SOLUTION 5 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047410",
      "ndc_label_name": "Haloperidol Lactate SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045073701",
      "ndc_label_name": "Haloperidol Lactate Solution 5 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047491",
      "ndc_label_name": "Haloperidol Lactate SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457042600",
      "ndc_label_name": "Haloperidol Lactate SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457042612",
      "ndc_label_name": "Haloperidol Lactate SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154955305",
      "ndc_label_name": "Haloperidol Lactate SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045073710",
      "ndc_label_name": "Haloperidol Lactate Solution 5 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323047401",
      "ndc_label_name": "Haloperidol Lactate SOLUTION 5 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135075201",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079073301",
      "ndc_label_name": "Haloperidol TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832151011",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904724061",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382040701",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378035101",
      "ndc_label_name": "Haloperidol TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378035110",
      "ndc_label_name": "Haloperidol TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904738961",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657090001",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071049430",
      "ndc_label_name": "Haloperidol TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756000111",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090598900",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335288001",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71247015001",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651078901",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657070001",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292058001",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162168301",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756000112",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079073320",
      "ndc_label_name": "Haloperidol TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266701",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629927001",
      "ndc_label_name": "Haloperidol Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135075301",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657070101",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378025710",
      "ndc_label_name": "Haloperidol TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651079001",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657090110",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832152001",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079073420",
      "ndc_label_name": "Haloperidol TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378025701",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079073401",
      "ndc_label_name": "Haloperidol TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71247015101",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292058201",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162168401",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382040801",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832152089",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756000211",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832152011",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657090101",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904724161",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335292601",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904739061",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756000212",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629927101",
      "ndc_label_name": "Haloperidol Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268039215",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832155011",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657090401",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573044202",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084024911",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651079301",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378033401",
      "ndc_label_name": "Haloperidol TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832155001",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904673361",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832155089",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382008001",
      "ndc_label_name": "Haloperidol TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268039211",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292058801",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135075601",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084024901",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079043101",
      "ndc_label_name": "Haloperidol TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71247015401",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657070401",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162168701",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079043120",
      "ndc_label_name": "Haloperidol TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629232601",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756024211",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756024212",
      "ndc_label_name": "Haloperidol Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904724261",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378021401",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135075401",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904739161",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71247015201",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378021410",
      "ndc_label_name": "Haloperidol TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079073501",
      "ndc_label_name": "Haloperidol TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832153011",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573044002",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657090201",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079073520",
      "ndc_label_name": "Haloperidol TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904750461",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657070201",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162168501",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292058401",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756000311",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756000312",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651079101",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629927201",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382040901",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267084730",
      "ndc_label_name": "Haloperidol TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335292901",
      "ndc_label_name": "Haloperidol Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268039311",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135075701",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629927501",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657070501",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832156011",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378033501",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382008101",
      "ndc_label_name": "Haloperidol TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657090501",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084025021",
      "ndc_label_name": "Haloperidol TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268039315",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756023611",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084025011",
      "ndc_label_name": "Haloperidol TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904666104",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657090503",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292059001",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651079401",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162168801",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756023612",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71247015501",
      "ndc_label_name": "Haloperidol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090346800",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378032701",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832154089",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657070310",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090601700",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832154001",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378032710",
      "ndc_label_name": "Haloperidol TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079073601",
      "ndc_label_name": "Haloperidol TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292058601",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832154011",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090266800",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079073620",
      "ndc_label_name": "Haloperidol TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651079299",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268039111",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135075501",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657070301",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013330",
      "ndc_label_name": "Haloperidol TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904678261",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268039115",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657090301",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756000412",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292058610",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356009560",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687016111",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687016101",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573044102",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090436500",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629927301",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187084203",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629927401",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651079201",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382007910",
      "ndc_label_name": "Haloperidol TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71247015301",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756000411",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382007901",
      "ndc_label_name": "Haloperidol TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71247015310",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335291201",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162168600",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162168601",
      "ndc_label_name": "Haloperidol Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58160082601",
      "ndc_label_name": "Havrix Suspension 1440 EL U/ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082501",
      "ndc_label_name": "Havrix Suspension 720 EL U/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090150200",
      "ndc_label_name": "Havrix Suspension Prefilled Syringe 1440 EL U/ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082652",
      "ndc_label_name": "Havrix Suspension Prefilled Syringe 1440 EL U/ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082643",
      "ndc_label_name": "Havrix Suspension Prefilled Syringe 1440 EL U/ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090378100",
      "ndc_label_name": "Havrix Suspension Prefilled Syringe 720 EL U/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082543",
      "ndc_label_name": "Havrix Suspension Prefilled Syringe 720 EL U/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082552",
      "ndc_label_name": "Havrix Suspension Prefilled Syringe 720 EL U/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10758002003",
      "ndc_label_name": "Healthy Mama Be Well Rounded Therapy Pack 28-0.8 & 450 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63044063101",
      "ndc_label_name": "Hematogen Capsule Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16477020112",
      "ndc_label_name": "Hemmorex-HC Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16477020199",
      "ndc_label_name": "Hemmorex-HC Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16477020124",
      "ndc_label_name": "Hemmorex-HC Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16477020212",
      "ndc_label_name": "Hemmorex-HC Suppository 30 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00113094424",
      "ndc_label_name": "Hemorrhoidal Cream 1-0.25-14.4-15 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69396003318",
      "ndc_label_name": "Hemorrhoidal Cream 1-0.25-14.4-15 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000042501",
      "ndc_label_name": "Hemorrhoidal Cream 1-0.25-14.4-15 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54569258600",
      "ndc_label_name": "Hemorrhoidal-HC Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00245011212",
      "ndc_label_name": "Hemril-30 SUPPOSITORY 30 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323001710",
      "ndc_label_name": "Hep Flush-10 SOLUTION 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641038721",
      "ndc_label_name": "Hep-Lock Flush SOLUTION 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641027221",
      "ndc_label_name": "Hep-Lock SOLUTION 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641027321",
      "ndc_label_name": "Hep-Lock SOLUTION 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338811370",
      "ndc_label_name": "Heparin (Porcine) Lock Flush SOLUTION 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00074345425",
      "ndc_label_name": "Heparin (Porcine) Lock Flush SOLUTION 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306423",
      "ndc_label_name": "Heparin Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253044452",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 1 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253044422",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 1 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253044421",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 1 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253044423",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 1 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253044430",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 1 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253044425",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 1 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253044433",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 1 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253044435",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 1 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253022225",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253022221",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253022222",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253022223",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253022233",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306414",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253022252",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323055701",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253022230",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253022235",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253033322",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253033330",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253033333",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253033321",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323054901",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253033323",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306424",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253033325",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253033335",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253033352",
      "ndc_label_name": "Heparin Na (Pork) Lock Flsh PF Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807050031",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306512",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306509",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807050005",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807050055",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807056051",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409128032",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306511",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807050051",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306521",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306525",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807050050",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306510",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306527",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807050512",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68883001005",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807056031",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323054401",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323054411",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306515",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306531",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306513",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807060055",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306516",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306517",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807066051",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68883010003",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306528",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323054505",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08290306514",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323054501",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807060005",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807060031",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807060051",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807060512",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807066031",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68883010005",
      "ndc_label_name": "Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807050005",
      "ndc_label_name": "Heparin Sodium Lock Flush SOLUTION 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43528000301",
      "ndc_label_name": "Heplisav-B Solution Prefilled Syringe 20 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090235400",
      "ndc_label_name": "Hibiclens Liquid 4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00234057504",
      "ndc_label_name": "Hibiclens Solution 4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090235400",
      "ndc_label_name": "Hibiclens Solution 4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00234057508",
      "ndc_label_name": "Hibiclens Solution 4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00234057517",
      "ndc_label_name": "Hibiclens Solution 4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00234057580",
      "ndc_label_name": "Hibiclens Solution 4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00234057516",
      "ndc_label_name": "Hibiclens Solution 4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00234057591",
      "ndc_label_name": "Hibiclens Solution 4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "76420053508",
      "ndc_label_name": "Hibiclens Solution 4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00234057541",
      "ndc_label_name": "Hibiclens Solution 4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00234057532",
      "ndc_label_name": "Hibiclens Solution 4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00002751101",
      "ndc_label_name": "HumaLOG Mix 75/25 SUSPENSION (75-25) 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002751601",
      "ndc_label_name": "HumaLOG Solution Cartridge 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002751659",
      "ndc_label_name": "HumaLOG Solution Cartridge 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63833062701",
      "ndc_label_name": "Humate-P Solution Reconstituted 1000-2400 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63833061702",
      "ndc_label_name": "Humate-P SOLUTION RECONSTITUTED 1000-2400 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63833062601",
      "ndc_label_name": "Humate-P Solution Reconstituted 500-1200 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63833061602",
      "ndc_label_name": "Humate-P SOLUTION RECONSTITUTED 500-1200 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00002880301",
      "ndc_label_name": "HumuLIN 70/30 KwikPen Suspension Pen-injector (70-30) 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00002880359",
      "ndc_label_name": "HumuLIN 70/30 KwikPen Suspension Pen-injector (70-30) 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00002871501",
      "ndc_label_name": "HumuLIN 70/30 SUSPENSION (70-30) 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00002871517",
      "ndc_label_name": "HumuLIN 70/30 Suspension (70-30) 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00002880559",
      "ndc_label_name": "HumuLIN N KwikPen Suspension Pen-injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00002880501",
      "ndc_label_name": "HumuLIN N KwikPen Suspension Pen-injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00002831517",
      "ndc_label_name": "HumuLIN N Suspension 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00002831501",
      "ndc_label_name": "HumuLIN N SUSPENSION 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090035200",
      "ndc_label_name": "HumuLIN N Suspension 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090035300",
      "ndc_label_name": "HumuLIN R Solution 100 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00002021301",
      "ndc_label_name": "HumuLIN R Solution 100 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00002821517",
      "ndc_label_name": "HumuLIN R Solution 100 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00002821501",
      "ndc_label_name": "HumuLIN R SOLUTION 100 UNIT/ML INJECTION",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00002850101",
      "ndc_label_name": "HumuLIN R U-500 (CONCENTRATED) Solution 500 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002882401",
      "ndc_label_name": "HumuLIN R U-500 KwikPen Solution Pen-injector 500 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002882427",
      "ndc_label_name": "HumuLIN R U-500 KwikPen Solution Pen-injector 500 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722051901",
      "ndc_label_name": "HydrALAZINE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079007420",
      "ndc_label_name": "HydrALAZINE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440758090",
      "ndc_label_name": "HydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440758030",
      "ndc_label_name": "HydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629849401",
      "ndc_label_name": "HydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904644061",
      "ndc_label_name": "hydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155083201",
      "ndc_label_name": "hydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084044701",
      "ndc_label_name": "hydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687081101",
      "ndc_label_name": "hydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135057912",
      "ndc_label_name": "hydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904744761",
      "ndc_label_name": "hydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155000110",
      "ndc_label_name": "HydrALAZINE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162153500",
      "ndc_label_name": "hydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111039801",
      "ndc_label_name": "HydrALAZINE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629849301",
      "ndc_label_name": "HydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205009190",
      "ndc_label_name": "HydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282030901",
      "ndc_label_name": "HydrALAZINE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111039803",
      "ndc_label_name": "HydrALAZINE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155000101",
      "ndc_label_name": "HydrALAZINE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155083210",
      "ndc_label_name": "hydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162153501",
      "ndc_label_name": "hydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228018201",
      "ndc_label_name": "HydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282030910",
      "ndc_label_name": "HydrALAZINE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771018210",
      "ndc_label_name": "HydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228018210",
      "ndc_label_name": "HydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079007401",
      "ndc_label_name": "HydrALAZINE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687081111",
      "ndc_label_name": "hydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084044711",
      "ndc_label_name": "hydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205009160",
      "ndc_label_name": "hydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771018201",
      "ndc_label_name": "HydrALAZINE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904745061",
      "ndc_label_name": "hydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808701",
      "ndc_label_name": "HydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353012405",
      "ndc_label_name": "HydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155083501",
      "ndc_label_name": "hydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733003",
      "ndc_label_name": "HydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722052201",
      "ndc_label_name": "HydrALAZINE HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904644361",
      "ndc_label_name": "hydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155000401",
      "ndc_label_name": "hydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733006",
      "ndc_label_name": "HydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771018501",
      "ndc_label_name": "HydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722052205",
      "ndc_label_name": "hydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135058212",
      "ndc_label_name": "hydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849701",
      "ndc_label_name": "hydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353020505",
      "ndc_label_name": "HydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733002",
      "ndc_label_name": "HydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353091916",
      "ndc_label_name": "HydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733009",
      "ndc_label_name": "HydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111039701",
      "ndc_label_name": "HydrALAZINE HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162153801",
      "ndc_label_name": "hydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733001",
      "ndc_label_name": "HydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834012801",
      "ndc_label_name": "HydrALAZINE HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380073606",
      "ndc_label_name": "HydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241000605",
      "ndc_label_name": "hydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228018501",
      "ndc_label_name": "HydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629849501",
      "ndc_label_name": "HydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054902",
      "ndc_label_name": "hydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054905",
      "ndc_label_name": "HydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189001360",
      "ndc_label_name": "HydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282031201",
      "ndc_label_name": "HydrALAZINE HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804019730",
      "ndc_label_name": "hydrALAZINE HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090464105",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155000210",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022660",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904744861",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069492",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904644161",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069480",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155083301",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020203",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022680",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111032701",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722052010",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075680",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155000201",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075692",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022692",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804008172",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090013702",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111032703",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075660",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289013390",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155083310",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079007501",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090013704",
      "ndc_label_name": "HydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919031290",
      "ndc_label_name": "HydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261005",
      "ndc_label_name": "HydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228018310",
      "ndc_label_name": "HydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261004",
      "ndc_label_name": "HydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544065780",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722052001",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289013360",
      "ndc_label_name": "HydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090464104",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804008130",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228018301",
      "ndc_label_name": "HydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289013301",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687082211",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135058012",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069460",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584073301",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079007520",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739032710",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380073408",
      "ndc_label_name": "HydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584073311",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187090130",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020202",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090013705",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056180",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687082201",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056192",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241000411",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771018310",
      "ndc_label_name": "HydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544065792",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162153600",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154729400",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629849601",
      "ndc_label_name": "HydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282031010",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020201",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629875701",
      "ndc_label_name": "HydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544065760",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380073406",
      "ndc_label_name": "HydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162152100",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056160",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282031001",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834012601",
      "ndc_label_name": "HydrALAZINE HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771018301",
      "ndc_label_name": "HydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804008160",
      "ndc_label_name": "hydrALAZINE HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904644261",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904744961",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155083401",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440758292",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023060",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155083410",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155000310",
      "ndc_label_name": "HydrALAZINE HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155000301",
      "ndc_label_name": "HydrALAZINE HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722052110",
      "ndc_label_name": "HydrALAZINE HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074294",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023098",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722052101",
      "ndc_label_name": "HydrALAZINE HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063698",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023092",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999077700",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353067492",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074296",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721003",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353067460",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023080",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353067480",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063680",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251402",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353067498",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721002",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687083311",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353067496",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063660",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090013903",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063692",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090660800",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074280",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721004",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739032810",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074260",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353067494",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228018410",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074298",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629849701",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353074292",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079007620",
      "ndc_label_name": "HydrALAZINE HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380073508",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090013901",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228018401",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056280",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251401",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380073506",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056292",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771018410",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056260",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090013902",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135058112",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771018401",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721200",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090013904",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056298",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721001",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834012701",
      "ndc_label_name": "HydrALAZINE HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079007601",
      "ndc_label_name": "HydrALAZINE HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584073401",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687083301",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111032801",
      "ndc_label_name": "HydrALAZINE HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084690",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241000511",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584073411",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111032803",
      "ndc_label_name": "HydrALAZINE HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205007290",
      "ndc_label_name": "HydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282031101",
      "ndc_label_name": "HydrALAZINE HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162153700",
      "ndc_label_name": "hydrALAZINE HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834012700",
      "ndc_label_name": "HydrALAZINE HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282031110",
      "ndc_label_name": "HydrALAZINE HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268040411",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356080730",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999038860",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063560",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356080790",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378081005",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591034705",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378081001",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746038206",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291031590",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228014610",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090072402",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291031510",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300013010",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300013001",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591034701",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068301",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999038890",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289056507",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318600",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090072403",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318602",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090072400",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300013005",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068311",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090072401",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747509",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318601",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567202",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090698701",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318603",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567203",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187054807",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567200",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886203",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090698703",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090698700",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090698702",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567201",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228014601",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073960",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268040415",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886206",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228014605",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746038210",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289056560",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090698800",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289056530",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071025530",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289056590",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934015830",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237000201",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187054860",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919058071",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959042930",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289056598",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934032130",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919058090",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016107",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919058030",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747501",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886207",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289056514",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237000205",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934032190",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073932",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335077003",
      "ndc_label_name": "Hydrochlorothiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629849801",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788768301",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016130",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237000299",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747507",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098072",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788768309",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017630",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862011301",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788768307",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098055",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544073931",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886201",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162152805",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205058990",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747503",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862011399",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367021905",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098060",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788747506",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205058930",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335077002",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098000",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017606",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788768303",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335077001",
      "ndc_label_name": "Hydrochlorothiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098011",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335006701",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788768306",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335006703",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098030",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610050060",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886209",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017690",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367021901",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367021910",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934015890",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016190",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098090",
      "ndc_label_name": "HydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335006702",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335006704",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335006705",
      "ndc_label_name": "Hydrochlorothiazide CAPSULE 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013960",
      "ndc_label_name": "hydroCHLOROthiazide Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440759585",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440759589",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440759581",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440759510",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172208360",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440759591",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172208380",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440759560",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729018301",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063075595",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155000810",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300012810",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440759514",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063075507",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440759530",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300012801",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063075501",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071965",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063075530",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063093301",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440759594",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071930",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440759545",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071915",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073245",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014100",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024160",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024145",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729018317",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073230",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155000801",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071953",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039710",
      "ndc_label_name": "HydroCHLOROthiazide TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272700",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039711",
      "ndc_label_name": "HydroCHLOROthiazide TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073253",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071973",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073260",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063075560",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999016710",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272701",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002049700",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014000",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999016760",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073215",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014001",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063075590",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090270600",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090274400",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002049760",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272708",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348011030",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999016728",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090616000",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024130",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090505700",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090615708",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429088910",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407033101",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760019990",
      "ndc_label_name": "HydroCHLOROthiazide TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014008",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013200",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071945",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154148300",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090615800",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760043030",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059301",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187036710",
      "ndc_label_name": "HydroCHLOROthiazide TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090615701",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013230",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071960",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700000690",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407033110",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919029303",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629121801",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013110",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013260",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002049730",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071980",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700084330",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407033190",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187036703",
      "ndc_label_name": "HydroCHLOROthiazide TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899101",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267010614",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429088990",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429088901",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090601400",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760019930",
      "ndc_label_name": "HydroCHLOROthiazide TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655027226",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187036714",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788684406",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267010690",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059311",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135044805",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090615700",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919029360",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919029320",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862013301",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837803",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645051054",
      "ndc_label_name": "HydroCHLOROthiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760031530",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629121901",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700000630",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899103",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919029330",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788684401",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851703",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584036110",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135044890",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013101",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760031590",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788684400",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919029390",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812600",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001430",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584036190",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267010630",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862013399",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760043090",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788684403",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788684409",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837800",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048815",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934007490",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267010660",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812603",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899102",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764809",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764801",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934078930",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789029630",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205041914",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837806",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812606",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764800",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851709",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837801",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079390",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051290",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205041990",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851700",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812609",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764803",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013101",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584036195",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065202",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097200",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001453",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851701",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026115",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764806",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048853",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001415",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065207",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097272",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097211",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851706",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162135601",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812601",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038190",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048845",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789029690",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837809",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097230",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013110",
      "ndc_label_name": "Hydrochlorothiazide TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051260",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934078990",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097255",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934007430",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097290",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001445",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097260",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001460",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048860",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048830",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162135600",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789029660",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051230",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440759691",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172208980",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729018401",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440759660",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00172208960",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155000910",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440759630",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024045",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729018417",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440759690",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071730",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155000901",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440759694",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039810",
      "ndc_label_name": "HydroCHLOROthiazide TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300012910",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071753",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071709",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002036230",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014200",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024060",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300012901",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999027930",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071760",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073360",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071745",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429089001",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217100",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090615600",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063074701",
      "ndc_label_name": "HydroCHLOROthiazide TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013330",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073345",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014208",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039811",
      "ndc_label_name": "HydroCHLOROthiazide TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429089090",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090615601",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919029430",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267010715",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899203",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090615608",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217108",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014201",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135044990",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090653208",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013010",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841706",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862013401",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899201",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407033210",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217101",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629122001",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407033201",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013001",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788892806",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788892801",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267010790",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013300",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090653200",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544037030",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407033290",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584036290",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001560",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013010",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779000",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002036260",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090653201",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779001",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013390",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205075190",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610032360",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189051390",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841703",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919029460",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135044905",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788892809",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002036200",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026390",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097390",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097300",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788892803",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919029490",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629112101",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001545",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429089010",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097330",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899202",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030301",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047160",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013001",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779003",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862013499",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205009030",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267010760",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584036210",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779006",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804003190",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779009",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162135701",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841709",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205009090",
      "ndc_label_name": "HydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788892810",
      "ndc_label_name": "Hydrochlorothiazide TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610032345",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047145",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804003130",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097311",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097355",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097360",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097372",
      "ndc_label_name": "hydroCHLOROthiazide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "38485080868",
      "ndc_label_name": "Hydrocil Powder 95 % Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60432045516",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54569351500",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687027886",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121103605",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574110516",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121103640",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687027840",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121481105",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668057710",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950037147",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356043616",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121481140",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356020073",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702015016",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959058003",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383004316",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59741026216",
      "ndc_label_name": "HYDROcodone Bit-Homatrop MBr Solution 5-1.5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121077216",
      "ndc_label_name": "HYDROcodone-Acetaminophen Solution 7.5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950037316",
      "ndc_label_name": "HYDROcodone-Acetaminophen Solution 7.5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121231640",
      "ndc_label_name": "HYDROcodone-Acetaminophen Solution 7.5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121077204",
      "ndc_label_name": "HYDROcodone-Acetaminophen Solution 7.5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629194101",
      "ndc_label_name": "HYDROcodone-Acetaminophen Solution 7.5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689002350",
      "ndc_label_name": "HYDROcodone-Acetaminophen Solution 7.5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121231650",
      "ndc_label_name": "HYDROcodone-Acetaminophen Solution 7.5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687041744",
      "ndc_label_name": "HYDROcodone-Acetaminophen Solution 7.5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121231615",
      "ndc_label_name": "HYDROcodone-Acetaminophen Solution 7.5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788635201",
      "ndc_label_name": "Hydrocodone-Acetaminophen SOLUTION 7.5-325 MG/15ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687041771",
      "ndc_label_name": "HYDROcodone-Acetaminophen Solution 7.5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689002301",
      "ndc_label_name": "HYDROcodone-Acetaminophen Solution 7.5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950034316",
      "ndc_label_name": "HYDROcodone-Acetaminophen Solution 7.5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689002316",
      "ndc_label_name": "HYDROcodone-Acetaminophen Solution 7.5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689002304",
      "ndc_label_name": "HYDROcodone-Acetaminophen Solution 7.5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930002743",
      "ndc_label_name": "Hydrocodone-Acetaminophen Solution 7.5-325 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634014471",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012505",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012510",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012562",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012512",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012501",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440760710",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012523",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268040211",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527165105",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702019101",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527165101",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012560",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603388728",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107002101",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603388721",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436261201",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107002105",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702019150",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904682561",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603388732",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858020301",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808003703",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386035810",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436261204",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722099705",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808003702",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702019110",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107002199",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858020350",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722094301",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032475",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032410",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032425",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722094305",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436261202",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808003701",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999016940",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032405",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032490",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032430",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032428",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386035805",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032401",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722099701",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268040215",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032408",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059821",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059890",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059814",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090072901",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032402",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386035801",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059801",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700078190",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059830",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700078121",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700078130",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032403",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032442",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032400",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059840",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429059205",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700078160",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099160",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118017609",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032406",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746011005",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032415",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700059860",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760022030",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099190",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118017603",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429059201",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032420",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700078101",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032424",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760087160",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760087260",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687041811",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760087230",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919015660",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032440",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700078140",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032445",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012060",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077812",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760087130",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919011820",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012020",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032460",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118017607",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032450",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077815",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077830",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543205",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919015690",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077820",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032484",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919011871",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118017606",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077860",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629229801",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543406",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082830",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629229901",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746011001",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082860",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687041801",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629193801",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543201",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543409",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082890",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543203",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099130",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629247101",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919011860",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543209",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543204",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629782303",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077890",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543401",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118017601",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543402",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012030",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543404",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629782302",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629888603",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543206",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543408",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760022060",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543405",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629230001",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850063301",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267031920",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267031984",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543210",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380044201",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760022090",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629888605",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629294710",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267031900",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267031940",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267031991",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629782301",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071200103",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919011826",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973508",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543202",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267031930",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267031988",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335124806",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629888601",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071200109",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629247001",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335127102",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543407",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267031990",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267031992",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039972",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850063305",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205066030",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543207",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021501",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267031960",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930002112",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335124804",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021590",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335211802",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973506",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543208",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930002152",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071136100",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162128105",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973501",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162128100",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034820",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034860",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543400",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034872",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071200106",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039930",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973502",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804000330",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039990",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543403",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335124807",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930002113",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189065030",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543510",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973500",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162227101",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021530",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629888604",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034830",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034890",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865011201",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335274001",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039960",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162128101",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021560",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162199101",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162227105",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440760510",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012301",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012305",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603389032",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440760530",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012312",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00254203401",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012310",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527164901",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012362",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808003501",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702018901",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603389028",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603389021",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012330",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012323",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808003503",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440760520",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151800",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107001905",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702018910",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858020101",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527164905",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904682461",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722099605",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268040111",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268040115",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722094101",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107001901",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073730",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722094105",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702018950",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386035601",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073728",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436391801",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858020150",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151700",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073740",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386035605",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808003502",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084401",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746010905",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700065214",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436010902",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090177800",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077114",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386035610",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722099601",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090177807",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700065221",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077121",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073742",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436010905",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077130",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084307",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032454",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073745",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099230",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099214",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073750",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073715",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077140",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436010904",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084300",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077160",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099260",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629193901",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073760",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073720",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429059005",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073702",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151707",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099201",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049490",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629229301",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746010901",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073725",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187011215",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073790",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090151801",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687039611",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187011230",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629229401",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700065230",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746010910",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187011260",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700065260",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436010901",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760087030",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037530",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629782101",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077105",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700065215",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629542202",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077101",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700065290",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061830",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629542200",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071020306",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049408",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429059001",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629542205",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077115",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049430",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061860",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629782102",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973402",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049420",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687039601",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029620",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077190",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061872",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037520",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850063105",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973404",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049472",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760087360",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029630",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099290",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187011220",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629294610",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029640",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973407",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629229201",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037512",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029650",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049460",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037560",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629542204",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029660",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973409",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629542201",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037515",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029684",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061820",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629542208",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629542207",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084089509",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034308",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629888505",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629246801",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010067201",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061826",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629888501",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629888502",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335141704",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034390",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850063101",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629888503",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335141700",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061890",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380044001",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930001913",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335141705",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189064930",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029615",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029681",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335141701",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629542203",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973400",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034360",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973401",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629849901",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029625",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029690",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162127900",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029692",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973403",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071029691",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973408",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162198901",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084089511",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084089501",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034372",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189064920",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930001912",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335296901",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162127905",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335141708",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040760",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930001952",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162134101",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973405",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040772",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162127901",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034330",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162134105",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865011001",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034320",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420013330",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040730",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040790",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011612",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012423",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012412",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012410",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012401",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527165005",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012405",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00254203501",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107002001",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904682661",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012462",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603389128",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440761120",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702019001",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527165001",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702019050",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722094205",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386035701",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353050332",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702019010",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603389121",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808003601",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603389132",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436260501",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858020201",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090281706",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386035705",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808003602",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107002005",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386035710",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118389109",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436260504",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073528",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268040011",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268040015",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073560",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808003603",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073590",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429059105",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073550",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060324",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436260502",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073502",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073580",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722094201",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429059101",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020826",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073584",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060360",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073500",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760069230",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187065815",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073503",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162011550",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187013760",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060315",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700082330",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073542",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020872",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629543610",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073530",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010067301",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187065830",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060330",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118389103",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700082390",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629229501",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380044101",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073540",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973705",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162011510",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060356",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687040701",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760069290",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071030191",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850063201",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700082360",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162128005",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162011511",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700060390",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687040711",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020860",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335046601",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335046605",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118389106",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187065820",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335046608",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700082301",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020890",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071030140",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930002013",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035260",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760069260",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071030160",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335197001",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020830",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162134201",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335141905",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162199005",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035272",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919045230",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335197006",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162128006",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187065860",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035290",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335210405",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189019130",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865011101",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187065812",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973608",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040630",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629229701",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629194001",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930002012",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040660",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008000230",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629229601",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930002052",
      "ndc_label_name": "Hydrocodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040690",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071030130",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629246901",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162128000",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025790",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008000260",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629782201",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162128001",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850063205",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071030190",
      "ndc_label_name": "Hydrocodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335046609",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335197005",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973605",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335197007",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025730",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035230",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025760",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008000290",
      "ndc_label_name": "HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189027628",
      "ndc_label_name": "Hydrocortisone Acetate Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70512010130",
      "ndc_label_name": "Hydrocortisone Acetate Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "42494034112",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904734024",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571067621",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689010201",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42494034124",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440031224",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440031212",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42494030112",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090301800",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135075124",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42494030124",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328002912",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090633100",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904734012",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574709012",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629199501",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573600",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367024312",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834014724",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72056001012",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268041101",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571067642",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135075112",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70898010212",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268041112",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69680014424",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328002924",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72056001024",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407066512",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42494030101",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090038100",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73028010112",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407066524",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70795241201",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268041124",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73028010124",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629200601",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629199401",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70898020424",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834014712",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959025003",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097624",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097612",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629253001",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959025024",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69680014412",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367024324",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70795241202",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574709312",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 30 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629253101",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 30 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367026012",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 30 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39328012912",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 30 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42494030212",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 30 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713049312",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 30 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629199601",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 30 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71321060312",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 30 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24689010301",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 30 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42494034212",
      "ndc_label_name": "Hydrocortisone Acetate Suppository 30 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11917004953",
      "ndc_label_name": "Hydrocortisone CREAM 0.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959058103",
      "ndc_label_name": "Hydrocortisone Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672201002",
      "ndc_label_name": "Hydrocortisone Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00168001431",
      "ndc_label_name": "Hydrocortisone Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999041301",
      "ndc_label_name": "Hydrocortisone Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917004954",
      "ndc_label_name": "Hydrocortisone CREAM 0.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672201001",
      "ndc_label_name": "Hydrocortisone Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00316019320",
      "ndc_label_name": "Hydrocortisone CREAM 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00316019316",
      "ndc_label_name": "Hydrocortisone CREAM 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472033730",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472033720",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168008016",
      "ndc_label_name": "Hydrocortisone CREAM 2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999016201",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999016228",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168008031",
      "ndc_label_name": "Hydrocortisone CREAM 2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802000403",
      "ndc_label_name": "Hydrocortisone CREAM 2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00316019330",
      "ndc_label_name": "Hydrocortisone CREAM 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090024400",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090343400",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802000402",
      "ndc_label_name": "Hydrocortisone CREAM 2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629866601",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858302",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999016220",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959001902",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672300302",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002096666",
      "ndc_label_name": "Hydrocortisone CREAM 2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090599900",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090035000",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036430",
      "ndc_label_name": "Hydrocortisone CREAM 2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162138202",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262100",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118994503",
      "ndc_label_name": "Hydrocortisone CREAM 2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959001901",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002096658",
      "ndc_label_name": "Hydrocortisone CREAM 2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959001903",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189062530",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700032130",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629866701",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267096701",
      "ndc_label_name": "Hydrocortisone CREAM 2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162138204",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055428",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013528",
      "ndc_label_name": "Hydrocortisone Cream 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559013807",
      "ndc_label_name": "Hydrocortisone ENEMA 100 MG/60ML Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135002007",
      "ndc_label_name": "Hydrocortisone Enema 100 MG/60ML Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135002046",
      "ndc_label_name": "Hydrocortisone Enema 100 MG/60ML Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155092681",
      "ndc_label_name": "Hydrocortisone Enema 100 MG/60ML Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155092651",
      "ndc_label_name": "Hydrocortisone Enema 100 MG/60ML Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135002021",
      "ndc_label_name": "Hydrocortisone Enema 100 MG/60ML Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559013811",
      "ndc_label_name": "Hydrocortisone Enema 100 MG/60ML Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71399012001",
      "ndc_label_name": "Hydrocortisone Lotion 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00394085932",
      "ndc_label_name": "Hydrocortisone LOTION 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00168028802",
      "ndc_label_name": "Hydrocortisone Lotion 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802093726",
      "ndc_label_name": "Hydrocortisone Lotion 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335291801",
      "ndc_label_name": "Hydrocortisone Lotion 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629252901",
      "ndc_label_name": "Hydrocortisone Lotion 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802093716",
      "ndc_label_name": "Hydrocortisone Lotion 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629941601",
      "ndc_label_name": "Hydrocortisone Lotion 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629866801",
      "ndc_label_name": "Hydrocortisone Lotion 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162144104",
      "ndc_label_name": "Hydrocortisone Lotion 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162144107",
      "ndc_label_name": "Hydrocortisone Lotion 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672201502",
      "ndc_label_name": "Hydrocortisone OINTMENT 0.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917004955",
      "ndc_label_name": "Hydrocortisone OINTMENT 0.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090023800",
      "ndc_label_name": "Hydrocortisone Ointment 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802027603",
      "ndc_label_name": "Hydrocortisone OINTMENT 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59390008017",
      "ndc_label_name": "Hydrocortisone OINTMENT 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00168002016",
      "ndc_label_name": "Hydrocortisone OINTMENT 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168002031",
      "ndc_label_name": "Hydrocortisone OINTMENT 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959063100",
      "ndc_label_name": "Hydrocortisone Ointment 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00472034556",
      "ndc_label_name": "Hydrocortisone Ointment 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917006914",
      "ndc_label_name": "Hydrocortisone OINTMENT 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672201802",
      "ndc_label_name": "Hydrocortisone OINTMENT 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917004957",
      "ndc_label_name": "Hydrocortisone OINTMENT 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205003430",
      "ndc_label_name": "Hydrocortisone Ointment 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090652600",
      "ndc_label_name": "Hydrocortisone Ointment 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70403092230",
      "ndc_label_name": "Hydrocortisone Ointment 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69396000320",
      "ndc_label_name": "Hydrocortisone Ointment 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162228402",
      "ndc_label_name": "Hydrocortisone Ointment 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00168014616",
      "ndc_label_name": "Hydrocortisone OINTMENT 2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802001402",
      "ndc_label_name": "Hydrocortisone OINTMENT 2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629252801",
      "ndc_label_name": "Hydrocortisone Ointment 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002087858",
      "ndc_label_name": "Hydrocortisone OINTMENT 2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629252701",
      "ndc_label_name": "Hydrocortisone Ointment 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802001405",
      "ndc_label_name": "Hydrocortisone OINTMENT 2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002087866",
      "ndc_label_name": "Hydrocortisone OINTMENT 2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168014630",
      "ndc_label_name": "Hydrocortisone OINTMENT 2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162138307",
      "ndc_label_name": "Hydrocortisone Ointment 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629905701",
      "ndc_label_name": "Hydrocortisone Ointment 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629881701",
      "ndc_label_name": "Hydrocortisone Ointment 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090052700",
      "ndc_label_name": "Hydrocortisone Ointment 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804008420",
      "ndc_label_name": "Hydrocortisone Ointment 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162138304",
      "ndc_label_name": "Hydrocortisone Ointment 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097000467",
      "ndc_label_name": "Hydrocortisone Sod Suc (PF) Solution Reconstituted 100 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789009401",
      "ndc_label_name": "Hydrocortisone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135055290",
      "ndc_label_name": "Hydrocortisone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904718861",
      "ndc_label_name": "Hydrocortisone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115169701",
      "ndc_label_name": "Hydrocortisone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762007401",
      "ndc_label_name": "Hydrocortisone TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543097106",
      "ndc_label_name": "Hydrocortisone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789022801",
      "ndc_label_name": "Hydrocortisone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268040611",
      "ndc_label_name": "Hydrocortisone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058201",
      "ndc_label_name": "Hydrocortisone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058211",
      "ndc_label_name": "Hydrocortisone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268040615",
      "ndc_label_name": "Hydrocortisone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651041401",
      "ndc_label_name": "Hydrocortisone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954005310",
      "ndc_label_name": "Hydrocortisone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380097106",
      "ndc_label_name": "Hydrocortisone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930007912",
      "ndc_label_name": "Hydrocortisone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268040711",
      "ndc_label_name": "Hydrocortisone Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115170001",
      "ndc_label_name": "Hydrocortisone Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135018660",
      "ndc_label_name": "Hydrocortisone Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930008012",
      "ndc_label_name": "Hydrocortisone Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954005410",
      "ndc_label_name": "Hydrocortisone Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543097206",
      "ndc_label_name": "Hydrocortisone Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762007501",
      "ndc_label_name": "Hydrocortisone TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789006201",
      "ndc_label_name": "Hydrocortisone Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162201801",
      "ndc_label_name": "Hydrocortisone Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651041501",
      "ndc_label_name": "Hydrocortisone Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789022901",
      "ndc_label_name": "Hydrocortisone Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268040715",
      "ndc_label_name": "Hydrocortisone Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380097206",
      "ndc_label_name": "Hydrocortisone Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268040511",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651041350",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762007301",
      "ndc_label_name": "Hydrocortisone TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789009550",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845503",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115169606",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268040515",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543097025",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845506",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380097025",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135055160",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687084411",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930007850",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835303",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835306",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687084421",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954005210",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845509",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687084465",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835309",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789022750",
      "ndc_label_name": "Hydrocortisone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71656006410",
      "ndc_label_name": "Hydrocortisone-Acetic Acid Solution 1-2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713084909",
      "ndc_label_name": "Hydrocortisone-Acetic Acid Solution 1-2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672300701",
      "ndc_label_name": "Hydrocortisone-Acetic Acid Solution 1-2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383090110",
      "ndc_label_name": "Hydrocortisone-Acetic Acid Solution 1-2 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42254029330",
      "ndc_label_name": "Hydrocortisone-Aloe CREAM 0.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205027210",
      "ndc_label_name": "Hydrocortisone-Aloe Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00295134797",
      "ndc_label_name": "Hydrolatum OINTMENT EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00295134796",
      "ndc_label_name": "Hydrolatum OINTMENT EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "35356081630",
      "ndc_label_name": "HYDROmorphone HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107010701",
      "ndc_label_name": "HYDROmorphone HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406324301",
      "ndc_label_name": "HYDROmorphone HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858030125",
      "ndc_label_name": "HYDROmorphone HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026502",
      "ndc_label_name": "HYDROmorphone HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162108103",
      "ndc_label_name": "HYDROmorphone HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162108100",
      "ndc_label_name": "HYDROmorphone HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527135301",
      "ndc_label_name": "HYDROmorphone HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162108106",
      "ndc_label_name": "HYDROmorphone HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959042002",
      "ndc_label_name": "HYDROmorphone HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858030101",
      "ndc_label_name": "HYDROmorphone HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629428409",
      "ndc_label_name": "HYDROmorphone HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687057901",
      "ndc_label_name": "HYDROmorphone HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026509",
      "ndc_label_name": "HYDROmorphone HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687057911",
      "ndc_label_name": "HYDROmorphone HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026503",
      "ndc_label_name": "HYDROmorphone HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335030301",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858030225",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054026424",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335970100",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406324401",
      "ndc_label_name": "HYDROmorphone HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054026425",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356081590",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335970107",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335072307",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335030307",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527135401",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107010801",
      "ndc_label_name": "HYDROmorphone HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356081560",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059011",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040830",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335970101",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858030201",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858030250",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059001",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162108206",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040802",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629379810",
      "ndc_label_name": "HYDROmorphone HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335072301",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040860",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162108203",
      "ndc_label_name": "HYDROmorphone HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093240101",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704606",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571068701",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714011001",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781599401",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571011250",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378037301",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440761530",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079480",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385092705",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714075301",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714011002",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005160",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571068750",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781599405",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440761560",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353097253",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010360",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729048501",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079416",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010380",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729048516",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704661",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571011201",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664076188",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090343202",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010353",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079460",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353076153",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010309",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005109",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385092701",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013230",
      "ndc_label_name": "Hydroxychloroquine Sulfate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090465902",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353076180",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598072101",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079453",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090250801",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090557301",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005153",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629334301",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567502",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353097209",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090343201",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598072105",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090250802",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090730601",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090465901",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009601",
      "ndc_label_name": "Hydroxychloroquine Sulfate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268041211",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353097260",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090628002",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999037260",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090557302",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746078005",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084026901",
      "ndc_label_name": "Hydroxychloroquine Sulfate TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774703",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084026911",
      "ndc_label_name": "Hydroxychloroquine Sulfate TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567501",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777008",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090628001",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090730602",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993005702",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335281301",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162246701",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004780",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090662900",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238154405",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268041215",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959017600",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777002",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004753",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651088901",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385014450",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090730700",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004730",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739077710",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959017660",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238154401",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070153",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993005704",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746078001",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664076113",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610050730",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004709",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135075290",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335281401",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096180",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610050630",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009605",
      "ndc_label_name": "Hydroxychloroquine Sulfate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651088905",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610050753",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619013101",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777003",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009004505",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002601",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774702",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777004",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000101",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070180",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777001",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096130",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004760",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385014401",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610050653",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162246705",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096153",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619013102",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000105",
      "ndc_label_name": "Hydroxychloroquine Sulfate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084028411",
      "ndc_label_name": "Hydroxyurea CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291032101",
      "ndc_label_name": "Hydroxyurea Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407090901",
      "ndc_label_name": "Hydroxyurea Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429026501",
      "ndc_label_name": "Hydroxyurea Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440761310",
      "ndc_label_name": "Hydroxyurea Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069082001",
      "ndc_label_name": "Hydroxyurea Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440761320",
      "ndc_label_name": "Hydroxyurea Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555088202",
      "ndc_label_name": "Hydroxyurea CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315016401",
      "ndc_label_name": "Hydroxyurea Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440761360",
      "ndc_label_name": "Hydroxyurea Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904693961",
      "ndc_label_name": "Hydroxyurea Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135070201",
      "ndc_label_name": "Hydroxyurea Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884072401",
      "ndc_label_name": "Hydroxyurea CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084028401",
      "ndc_label_name": "Hydroxyurea CAPSULE 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135005052",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135075047",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856005205",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121103416",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121482225",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090027601",
      "ndc_label_name": "HydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135005024",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54838050280",
      "ndc_label_name": "HydrOXYzine HCl SYRUP 10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856050701",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135050247",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452039588",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432015016",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959058203",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033003105",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432015004",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954091210",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033003144",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83745023216",
      "ndc_label_name": "hydrOXYzine HCl Syrup 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093506001",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135081001",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440761630",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135081010",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534020401",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155050005",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090668200",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093506005",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904737780",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702001001",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534020403",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806015905",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714008110",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063094330",
      "ndc_label_name": "HydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959048110",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904737740",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571011350",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702001050",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760028520",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090668203",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714008111",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959048130",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959048120",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155050001",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155050010",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534020404",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084025311",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084025301",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658078105",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064630",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651049901",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356012360",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090411700",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571011301",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026804",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767603",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806015910",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026806",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335263602",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096001",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090411703",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806015901",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335263603",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205054130",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096082",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162251105",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335263605",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090281800",
      "ndc_label_name": "HydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651049905",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407096910",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027130",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026802",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090281803",
      "ndc_label_name": "HydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189033330",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687066411",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135057305",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687066401",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959048112",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026801",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335263604",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739048310",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189033372",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026807",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011240",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026803",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760024520",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335263601",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162251101",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335263608",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760030720",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026808",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135057312",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335112101",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629873801",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335112104",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011215",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335303401",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011230",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133209",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011260",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871603",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887203",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026805",
      "ndc_label_name": "HydrOXYzine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335263606",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335263607",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133203",
      "ndc_label_name": "hydrOXYzine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702001110",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714008211",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904661761",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093506105",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093506101",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440761721",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440761715",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534020503",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714008210",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090265000",
      "ndc_label_name": "HydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135081110",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440761706",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093506110",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534020501",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904737840",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534020504",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658078210",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090665500",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571011401",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440761716",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440761704",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571011410",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135081101",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090265001",
      "ndc_label_name": "HydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051812",
      "ndc_label_name": "HydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090665700",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051840",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155050105",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440761730",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806016001",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702001101",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090265004",
      "ndc_label_name": "HydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051820",
      "ndc_label_name": "HydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733004",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051860",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806016005",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904737880",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051806",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702001150",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090293001",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090662600",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733006",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002450",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051830",
      "ndc_label_name": "HydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571011450",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051828",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714008212",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090336204",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733000",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007412",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264801",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051890",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155050101",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096201",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096282",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090665501",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007420",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007415",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090328601",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264804",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155050110",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264800",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002490",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090665504",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007421",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651050005",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090703400",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264806",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806016010",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090336206",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090174301",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007450",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760099030",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919012215",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733001",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090440400",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096295",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090529700",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090265006",
      "ndc_label_name": "HydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007460",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919021730",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629874001",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733201",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651050099",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002420",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090662800",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090662400",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919012220",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074330",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746401",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407097010",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074315",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090336200",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090665506",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007413",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919012230",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073360",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785406",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007424",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135057405",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090336201",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090665900",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007416",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919085660",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084025411",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205027320",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067501",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135057412",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090358301",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733200",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651050001",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187060520",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870706",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335245103",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919021790",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073320",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090732700",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007490",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084025401",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629796302",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335104701",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335277603",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919085630",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073330",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090758201",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700082930",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746402",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870709",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068660",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162251200",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629796301",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785403",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007430",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074360",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746405",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205015520",
      "ndc_label_name": "HydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073553",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021612",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739048610",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785409",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007440",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629185603",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934023430",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335093501",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084453",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425036502",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870703",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934071660",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067511",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011315",
      "ndc_label_name": "HydrOXYzine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205015516",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335104703",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133309",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746409",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335104702",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335104708",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760097130",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934015030",
      "ndc_label_name": "HydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335245101",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335277606",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074390",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205015530",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335104705",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335245106",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746403",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335104706",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335245102",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068653",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746406",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084460",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085153",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085160",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934032460",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084480",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335277601",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068680",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205015510",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085130",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133302",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133305",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205015560",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133304",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335277604",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073530",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205027330",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133306",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162251205",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133308",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335277602",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085170",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335277607",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085180",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335277605",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133303",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335303501",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021620",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335277608",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021630",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073560",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021690",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073570",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162251201",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073580",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021604",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021640",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425036503",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021660",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425036501",
      "ndc_label_name": "hydrOXYzine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093506201",
      "ndc_label_name": "HydrOXYzine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714008311",
      "ndc_label_name": "HydrOXYzine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135081201",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702001210",
      "ndc_label_name": "HydrOXYzine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904661861",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093506205",
      "ndc_label_name": "HydrOXYzine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714008310",
      "ndc_label_name": "HydrOXYzine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806016105",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904737980",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806016110",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135081210",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702001250",
      "ndc_label_name": "HydrOXYzine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904737940",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702001201",
      "ndc_label_name": "HydrOXYzine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999003560",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096395",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571011550",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063051930",
      "ndc_label_name": "HydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155050205",
      "ndc_label_name": "HydrOXYzine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534020601",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534020603",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806016101",
      "ndc_label_name": "HydrOXYzine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436387503",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090629301",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068601",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335241005",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096301",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11534020604",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571011501",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090639504",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407097110",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088230",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135057512",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135057505",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261401",
      "ndc_label_name": "HydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155050201",
      "ndc_label_name": "HydrOXYzine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571011510",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162216700",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068611",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651050101",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205033215",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017302",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090629304",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658078310",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155050210",
      "ndc_label_name": "HydrOXYzine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425037601",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187035430",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687087511",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162251305",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063077930",
      "ndc_label_name": "HydrOXYzine HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090639501",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335218504",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261404",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084025511",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651050199",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017301",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425037602",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039401",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084025501",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039402",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700076090",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205008315",
      "ndc_label_name": "HydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651050105",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335024603",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687087501",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335106803",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162251300",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335303601",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162251301",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026930",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789037830",
      "ndc_label_name": "hydrOXYzine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555032402",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420092230",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420092201",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999003612",
      "ndc_label_name": "HydrOXYzine Pamoate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420092290",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999003660",
      "ndc_label_name": "HydrOXYzine Pamoate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420092260",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555032302",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353019970",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185067405",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115180302",
      "ndc_label_name": "HydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904706561",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185067401",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115180301",
      "ndc_label_name": "HydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "14539067405",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090438505",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353019980",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762004",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353009470",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043320",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291040650",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555032304",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291040690",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407000105",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090035502",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "14539067401",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090035505",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084084711",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353019953",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040630",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063017201",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043340",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298405",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040601",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090457902",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728003",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043310",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090281300",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063017204",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700086030",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090300400",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040610",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268039811",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788756401",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002062130",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298402",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043315",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728009",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043350",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040615",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268039850",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776701",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700023730",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090438502",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043330",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776706",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700086090",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353009430",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407000101",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811905",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788756406",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002062115",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959043360",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205043330",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035760",
      "ndc_label_name": "HydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353009453",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002062110",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012330",
      "ndc_label_name": "HydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776709",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919088015",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002062120",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021730",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919088060",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353009460",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687069611",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009553",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009530",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629887701",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687069601",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021753",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084084701",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353019930",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980016901",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009570",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009560",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629961201",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035715",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021780",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728005",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353019960",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728006",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039770",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039753",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980016905",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187076330",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074730",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788756409",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090457905",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776705",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074780",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088353",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728001",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788728002",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162105403",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205008730",
      "ndc_label_name": "HydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002062140",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335099802",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189000915",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088380",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788756403",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788756405",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420092001",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205055830",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035730",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335171402",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776703",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420092060",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135081612",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811903",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811901",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335132502",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629887401",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335300301",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205048330",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335275101",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077330",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811906",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009580",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021770",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077370",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023960",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021760",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039760",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088360",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811909",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039730",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074760",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420092005",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039780",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420092090",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074770",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335171407",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077380",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074753",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088330",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077353",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077360",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088370",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189000930",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420092030",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115180402",
      "ndc_label_name": "HydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185067605",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555030202",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "14539067501",
      "ndc_label_name": "HydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185067601",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555030204",
      "ndc_label_name": "HydrOXYzine Pamoate CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115180401",
      "ndc_label_name": "HydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762542001",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064790",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "14539067505",
      "ndc_label_name": "HydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090754001",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090593400",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291040790",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291040750",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090266400",
      "ndc_label_name": "HydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687070701",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980017005",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090037401",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407000205",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090754000",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090328401",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687070765",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090277700",
      "ndc_label_name": "HydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135081712",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335207604",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407000201",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959083306",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268039911",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090593301",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064730",
      "ndc_label_name": "HydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090447101",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788878903",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189048030",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687070711",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959083320",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980017001",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268039950",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335207602",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811103",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189048090",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420092105",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335207605",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700074290",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420092101",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420092160",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335207601",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420092130",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335207603",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420092190",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335207606",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031530",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031590",
      "ndc_label_name": "hydrOXYzine Pamoate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328004816",
      "ndc_label_name": "Hyoscyamine Sulfate Elixir 0.125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657042716",
      "ndc_label_name": "Hyoscyamine Sulfate Elixir 0.125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135051147",
      "ndc_label_name": "Hyoscyamine Sulfate Elixir 0.125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16477073801",
      "ndc_label_name": "Hyoscyamine Sulfate ER Tablet Extended Release 12 Hour 0.375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328005210",
      "ndc_label_name": "Hyoscyamine Sulfate ER Tablet Extended Release 12 Hour 0.375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781001401",
      "ndc_label_name": "Hyoscyamine Sulfate ER Tablet Extended Release 12 Hour 0.375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629386002",
      "ndc_label_name": "Hyoscyamine Sulfate ER Tablet Extended Release 12 Hour 0.375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629386001",
      "ndc_label_name": "Hyoscyamine Sulfate ER Tablet Extended Release 12 Hour 0.375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51525011501",
      "ndc_label_name": "Hyoscyamine Sulfate ER Tablet Extended Release 12 Hour 0.375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57629020310",
      "ndc_label_name": "Hyoscyamine Sulfate ER Tablet Extended Release 12 Hour 0.375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135086060",
      "ndc_label_name": "Hyoscyamine Sulfate ER Tablet Extended Release 12 Hour 0.375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559042301",
      "ndc_label_name": "Hyoscyamine Sulfate ER Tablet Extended Release 12 Hour 0.375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135051352",
      "ndc_label_name": "Hyoscyamine Sulfate Solution 0.125 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328004715",
      "ndc_label_name": "Hyoscyamine Sulfate Solution 0.125 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629114401",
      "ndc_label_name": "Hyoscyamine Sulfate Solution 0.125 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781001301",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51525011201",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57629020010",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328005010",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959017530",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367067701",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192034001",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162193901",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959017502",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70156010401",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629102801",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71186000825",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559042101",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096564",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135051212",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096572",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071005104",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096590",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096560",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096500",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096578",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804096530",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367067901",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135018401",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192033801",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57629020210",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629103001",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781001201",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328004910",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162194101",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43199001201",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559042201",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135085812",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70156010601",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71186000725",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Dispersible 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192033901",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Sublingual 0.125 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51525011301",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Sublingual 0.125 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063032160",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Sublingual 0.125 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43199001101",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Sublingual 0.125 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781001101",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Sublingual 0.125 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135085912",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Sublingual 0.125 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629103101",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Sublingual 0.125 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328005110",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Sublingual 0.125 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559042401",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Sublingual 0.125 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57629020110",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Sublingual 0.125 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70156010501",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Sublingual 0.125 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629483803",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Sublingual 0.125 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71186000925",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Sublingual 0.125 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162194001",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Sublingual 0.125 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335078802",
      "ndc_label_name": "Hyoscyamine Sulfate Tablet Sublingual 0.125 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111057511",
      "ndc_label_name": "Ibandronate Sodium TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015053",
      "ndc_label_name": "Ibandronate Sodium Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015052",
      "ndc_label_name": "Ibandronate Sodium Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111057503",
      "ndc_label_name": "Ibandronate Sodium TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781010333",
      "ndc_label_name": "Ibandronate Sodium Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015001",
      "ndc_label_name": "Ibandronate Sodium Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781010307",
      "ndc_label_name": "Ibandronate Sodium Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781010321",
      "ndc_label_name": "Ibandronate Sodium Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862023703",
      "ndc_label_name": "Ibandronate Sodium TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111057543",
      "ndc_label_name": "Ibandronate Sodium Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090765400",
      "ndc_label_name": "Ibandronate Sodium Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452037874",
      "ndc_label_name": "Ibandronate Sodium Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429064373",
      "ndc_label_name": "Ibandronate Sodium TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505279500",
      "ndc_label_name": "Ibandronate Sodium TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069018821",
      "ndc_label_name": "Ibrance CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069018921",
      "ndc_label_name": "Ibrance CAPSULE 125 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069018721",
      "ndc_label_name": "Ibrance CAPSULE 75 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069048607",
      "ndc_label_name": "Ibrance Tablet 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069048603",
      "ndc_label_name": "Ibrance Tablet 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069068803",
      "ndc_label_name": "Ibrance Tablet 125 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069068807",
      "ndc_label_name": "Ibrance Tablet 125 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069028407",
      "ndc_label_name": "Ibrance Tablet 75 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069028403",
      "ndc_label_name": "Ibrance Tablet 75 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "40986001741",
      "ndc_label_name": "Ibuprofen and PSE Cold & Sinus TABLET 200-30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536114730",
      "ndc_label_name": "Ibuprofen Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363013220",
      "ndc_label_name": "Ibuprofen CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230014680",
      "ndc_label_name": "Ibuprofen Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230014640",
      "ndc_label_name": "Ibuprofen Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363012318",
      "ndc_label_name": "Ibuprofen CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363012140",
      "ndc_label_name": "Ibuprofen CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000036001",
      "ndc_label_name": "Ibuprofen Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917011658",
      "ndc_label_name": "Ibuprofen CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917010270",
      "ndc_label_name": "Ibuprofen CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230014652",
      "ndc_label_name": "Ibuprofen Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000057103",
      "ndc_label_name": "Ibuprofen Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000057102",
      "ndc_label_name": "Ibuprofen Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363012330",
      "ndc_label_name": "Ibuprofen CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000036003",
      "ndc_label_name": "Ibuprofen Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090350700",
      "ndc_label_name": "Ibuprofen Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363013280",
      "ndc_label_name": "Ibuprofen CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917010272",
      "ndc_label_name": "Ibuprofen CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230014620",
      "ndc_label_name": "Ibuprofen Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000036002",
      "ndc_label_name": "Ibuprofen Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000057101",
      "ndc_label_name": "Ibuprofen Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121091400",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121102205",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00472176394",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00472176494",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802014026",
      "ndc_label_name": "Ibuprofen Childrens SUSPENSION 100 MG/5ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800068526",
      "ndc_label_name": "Ibuprofen Childrens SUSPENSION 100 MG/5ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00472176194",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121091405",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629854001",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090412900",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917009741",
      "ndc_label_name": "Ibuprofen Childrens SUSPENSION 100 MG/5ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802089734",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090765300",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802089726",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629885101",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121102200",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629885301",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001052194",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672213008",
      "ndc_label_name": "Ibuprofen Childrens SUSPENSION 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090340800",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672213808",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090322700",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788828801",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00472176098",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001052192",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094060059",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629885201",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090727400",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001043594",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63739079810",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230031011",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672213001",
      "ndc_label_name": "Ibuprofen Childrens SUSPENSION 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094049461",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094060062",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001043592",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672532108",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094049458",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788403601",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162228502",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672213801",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000026201",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230030912",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094049462",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094060061",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000026301",
      "ndc_label_name": "Ibuprofen Childrens SUSPENSION 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230030812",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230030911",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959029804",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000026401",
      "ndc_label_name": "Ibuprofen Childrens SUSPENSION 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205039572",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230031111",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230031012",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69618007854",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000018101",
      "ndc_label_name": "Ibuprofen Childrens SUSPENSION 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205021372",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63739079801",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162191102",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000025901",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000026302",
      "ndc_label_name": "Ibuprofen Childrens SUSPENSION 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094049459",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162191202",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70030064045",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83474000204",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788403101",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230030811",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230031112",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162191002",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162234102",
      "ndc_label_name": "Ibuprofen Childrens Suspension 100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121182800",
      "ndc_label_name": "Ibuprofen Childrens Suspension 200 MG/10ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121204410",
      "ndc_label_name": "Ibuprofen Childrens Suspension 200 MG/10ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121182810",
      "ndc_label_name": "Ibuprofen Childrens Suspension 200 MG/10ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121204400",
      "ndc_label_name": "Ibuprofen Childrens Suspension 200 MG/10ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000023901",
      "ndc_label_name": "Ibuprofen Junior Strength TABLET CHEWABLE 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363029214",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363029117",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363039215",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363029258",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363029108",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00404001713",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363029112",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440762510",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363029215",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363029208",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440762520",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00761035250",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363039212",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904674724",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363029115",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440762530",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363039214",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363029212",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536139047",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904674780",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00404001799",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904674759",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363029158",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904674770",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363039312",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363039216",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904791461",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917017756",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904674751",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917016368",
      "ndc_label_name": "Ibuprofen TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536139048",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917001407",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440762506",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440762590",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135018305",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16103040708",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056055",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16103040706",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800051771",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142060490",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440762524",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904674740",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917017764",
      "ndc_label_name": "Ibuprofen TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142060462",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999007190",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142060471",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056054",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800007478",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904791451",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904791251",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142051778",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142064762",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187059840",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142064778",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959018702",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800060462",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135018310",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904791259",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142060485",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800060485",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504000492",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800060471",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959018715",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056450",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917016366",
      "ndc_label_name": "Ibuprofen TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904791459",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142064790",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800064771",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504000497",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800060490",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959018721",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959018720",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917016367",
      "ndc_label_name": "Ibuprofen TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135018301",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800007471",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800064778",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504010905",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800064762",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289067360",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959018730",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917016369",
      "ndc_label_name": "Ibuprofen TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917020508",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800060478",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292055626",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504090405",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999007160",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896054001",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959018790",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "12634016171",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800051778",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292050653",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999007100",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788814801",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090522308",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896094125",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289067394",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142060478",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800064790",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056447",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999007120",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788814803",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959018700",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629146700",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63868034150",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292055617",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292055625",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090280900",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090522300",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788814806",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959018703",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63868034110",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504090452",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483060101",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292055700",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959018725",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51824006401",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788859001",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896094150",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63868034124",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788405101",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999007118",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959018710",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289067330",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959018724",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000017605",
      "ndc_label_name": "Ibuprofen TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60760052924",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788857601",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788645903",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999007150",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959018760",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896094105",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289067324",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000029101",
      "ndc_label_name": "Ibuprofen TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60760052940",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000000301",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788645906",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090522303",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289067317",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504000495",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289067350",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000030801",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61919012328",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000017501",
      "ndc_label_name": "Ibuprofen TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788645909",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959018740",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289067318",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504000692",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60760094124",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205035730",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504011005",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335022302",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788814805",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959018750",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61919012330",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267011520",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61919012360",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335022303",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788798302",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335022304",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000000302",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289067320",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504000695",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267011540",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267011530",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335022306",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788798303",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335191108",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000017604",
      "ndc_label_name": "Ibuprofen TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896094101",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267011524",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66424039610",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267011550",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335191106",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335022300",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789019120",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205078700",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896094110",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788405103",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788405105",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788798301",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335191109",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335022305",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788645902",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335191100",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896094120",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788645901",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788645905",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788859005",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187059806",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335074603",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788814809",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335191107",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187059810",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788814802",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000017502",
      "ndc_label_name": "Ibuprofen TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000059701",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267011590",
      "ndc_label_name": "Ibuprofen TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788814804",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000017505",
      "ndc_label_name": "Ibuprofen TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189017028",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788798305",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000017601",
      "ndc_label_name": "Ibuprofen TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000017508",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205035760",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000017503",
      "ndc_label_name": "Ibuprofen TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000030802",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205035724",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335022308",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000059702",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205035706",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335191101",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335191103",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335022301",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205035750",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335191104",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335022309",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335022307",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335074604",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789019130",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335191102",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789019121",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335191105",
      "ndc_label_name": "Ibuprofen Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440762616",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762604",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762615",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "25000012112",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762640",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762690",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060250",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762610",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291044095",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762606",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762620",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356070030",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762694",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904585361",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999009750",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788000805",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543096607",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762660",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762630",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582011110",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904585340",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788000801",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090005608",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084320",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353038992",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762691",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353038974",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084330",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634017171",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582011118",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090299608",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090005700",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999009718",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904585360",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090299603",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084340",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084306",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087210",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090581908",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090581802",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007500",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087206",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090300700",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087230",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087282",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087220",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667700",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667601",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007502",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087240",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090581800",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090299601",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353038980",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353038960",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436460401",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667702",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687044611",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087290",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090581900",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090300702",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090299604",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060201",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407083901",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090778900",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629146803",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090299600",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667603",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090516001",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090581903",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407083905",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002033715",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090778903",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629146806",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090581901",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667608",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667600",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090778901",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700069430",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651036005",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090778904",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774501",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090581904",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090778800",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007560",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293084301",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380080907",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011615",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293084305",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205046430",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667604",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407036905",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007590",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348083510",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162046410",
      "ndc_label_name": "Ibuprofen TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011690",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700069460",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045809",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007520",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007521",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154138000",
      "ndc_label_name": "Ibuprofen TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788403902",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011640",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877031901",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187096720",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610041474",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007530",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007540",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687044601",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788403903",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877031905",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820103",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788403901",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091692",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54738096002",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002033730",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919012430",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788711409",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788403905",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367039401",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788403906",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096980",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135040012",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54738096001",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187096715",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820106",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820101",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69512040090",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788711403",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189032430",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187096760",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651036001",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629146802",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820109",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006650",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006610",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788711405",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018582",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629146801",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629146804",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629146805",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843801",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062792",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045801",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788711406",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020120",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629146808",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629146807",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162046450",
      "ndc_label_name": "Ibuprofen TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843802",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064460",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091660",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788711408",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282071250",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380080906",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788711401",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436018002",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367039405",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018520",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096960",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774508",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006603",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011620",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788711402",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934050930",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006605",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018530",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189056430",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820102",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610041460",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011630",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774502",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205046415",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062760",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018560",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018590",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820105",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064480",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011660",
      "ndc_label_name": "Ibuprofen TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774505",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045805",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189032460",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057590",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020106",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820108",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020140",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788403908",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843809",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045806",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057501",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788403909",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057530",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843803",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013730",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774503",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045803",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069003",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013760",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774506",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045804",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843805",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610029692",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774509",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057560",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610029680",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006601",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843806",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436018001",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610041492",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934013030",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843808",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045802",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091680",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045807",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610029660",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335045808",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282071246",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062780",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610041480",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921018050",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013715",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73086021001",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064492",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282071210",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096992",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921018001",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189056460",
      "ndc_label_name": "Ibuprofen Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762704",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762760",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762706",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762791",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762794",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762710",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762730",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084501",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762790",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904585440",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "25000012212",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788000901",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291044195",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762720",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762740",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084515",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904585461",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543096507",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084510",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788000905",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999000601",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762792",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543301",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084530",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086710",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582011218",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086730",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582011210",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262500",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904585460",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543304",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084590",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086715",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063035206",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086740",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086701",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262501",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084540",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543500",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086706",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086721",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084504",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999000606",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086704",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262503",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060350",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728601",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086782",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086724",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086720",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262600",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086790",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090267000",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543305",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728800",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063093630",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262507",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086760",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262605",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031460",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543502",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543504",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436320002",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031492",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543300",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031480",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262900",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353039374",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543503",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728600",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293084401",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353039392",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728802",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353039360",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543200",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262604",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543508",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728605",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407037005",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262504",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728803",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353039380",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436460503",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728604",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543509",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728804",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407084001",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262505",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090732100",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060301",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007604",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728808",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436320003",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728805",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348083020",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543507",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436460501",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262502",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007616",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728809",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030130",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436320001",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54738096102",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407084005",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436460502",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262508",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007624",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007600",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014204",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293084405",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014201",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007621",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007640",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262509",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348083010",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007602",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014218",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007610",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014210",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014206",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007645",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262601",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014215",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007612",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014220",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007642",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014260",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014212",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007650",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090275100",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687045711",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007628",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014230",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007690",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014290",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014224",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007670",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543505",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037420",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007660",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014240",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014214",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700044500",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289041298",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037428",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728807",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060390",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746046560",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700044590",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651036105",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700044530",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037430",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059730",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007615",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062821",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154074100",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037460",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059760",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700044540",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060360",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059790",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007620",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098090",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651036101",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059720",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062890",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059728",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919012590",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062830",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007625",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788690906",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037440",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060328",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187061420",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060320",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919096060",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187045130",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007630",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788690909",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059740",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062860",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098050",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060330",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187045190",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187061428",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014221",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760209",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919012530",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187061430",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098060",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919096090",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877029501",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187061440",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014228",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818201",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919096030",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098042",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877029505",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187052730",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760207",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098021",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700044560",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818204",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135040112",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877029530",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877032001",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187061421",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818206",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380080806",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687045701",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827802",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098028",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877032050",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760206",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098015",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827801",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788690901",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060340",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835402",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162046510",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788690905",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827809",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098020",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835405",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760204",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919096072",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835408",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162046550",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788690908",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875403",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098040",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853103",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760205",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187061442",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853102",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267096400",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818202",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875406",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877032005",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875405",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818209",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098030",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853105",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788690902",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818205",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677022515",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877032030",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875408",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827804",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380080807",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853108",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760201",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835401",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006705",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788690903",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150060050",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827807",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877029550",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367039505",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760203",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835403",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205052220",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760202",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677022501",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677022520",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645056259",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436018101",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818208",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835406",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205052230",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760208",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006750",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934008030",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788690907",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120701",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827803",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835407",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335150307",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827805",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205052228",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205052260",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818203",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120703",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827806",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853104",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017680",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827808",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120704",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120706",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818207",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121800",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853101",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853107",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054780",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835404",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121808",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120709",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835409",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121803",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367039501",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875401",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062992",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875402",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335150308",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121802",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853106",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121805",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677022590",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875404",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064592",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677022560",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268303",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022260",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853109",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335150300",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006701",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875407",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089560",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934037590",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089160",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089580",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875409",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335150302",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006703",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69512060090",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090253",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268306",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089192",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096892",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150060010",
      "ndc_label_name": "Ibuprofen TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335150305",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120707",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934037530",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090260",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017660",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096880",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189064360",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677022530",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053260",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121801",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205052290",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090292",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062960",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189023121",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021215",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006710",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053280",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121806",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120700",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71862000301",
      "ndc_label_name": "Ibuprofen TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064560",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189064321",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036330",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436018102",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089570",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335150304",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120705",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189023130",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089153",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021206",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013202",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120708",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090270",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022280",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335150306",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021210",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018730",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021230",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013203",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121804",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096860",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054760",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064553",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021224",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018782",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036320",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042602",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121807",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036301",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054792",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064580",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036360",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018790",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036324",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042604",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121809",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036321",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062980",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089170",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042401",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021221",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73086021101",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055301",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335150301",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036390",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089592",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089180",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042404",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036315",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282071310",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055302",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335150303",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015402",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921018101",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921018150",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006660",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036340",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189064330",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189023160",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017692",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013201",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018760",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021220",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022292",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015401",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057601",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021290",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053292",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042403",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057630",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036310",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090280",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042601",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057690",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282071350",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021240",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006630",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015403",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006690",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057660",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015404",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055304",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042402",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042603",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055303",
      "ndc_label_name": "Ibuprofen Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762806",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084730",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762803",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762885",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762810",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762881",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762804",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762820",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762890",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085818",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762815",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762892",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762821",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904585561",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762889",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762830",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762891",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085824",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904585560",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904585540",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291044290",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291044295",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788001001",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762860",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063001306",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353039160",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291042850",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788001005",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582011310",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085801",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634068260",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440762894",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084724",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353039192",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42582011318",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291044230",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084715",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085812",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084720",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634068271",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084790",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999004245",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063001304",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543096407",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085806",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085820",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085804",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634068290",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063091430",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090544600",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085810",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084760",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085815",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085840",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085821",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "25000012312",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060401",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090544604",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353009580",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085860",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999004221",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085890",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085830",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084710",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999004206",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090544605",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027380",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085894",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090544607",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085893",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027392",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085809",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254803",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007706",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353039180",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353009560",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090661600",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353009592",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254802",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085828",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254804",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007714",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254800",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027360",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090790500",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353039174",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090259700",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085882",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254905",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007716",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254809",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090436805",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436032101",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254805",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090436804",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483060450",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254907",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014012",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090544405",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090544602",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293084501",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254807",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090436807",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254801",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728107",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014018",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090544500",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090688600",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407037105",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254808",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090544407",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728300",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728200",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651036205",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090544603",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728303",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007718",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254904",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090544608",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007702",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728301",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687046811",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090664500",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728309",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007745",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254906",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090544609",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007710",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728304",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059609",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728105",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436032102",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014001",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090544601",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728307",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007712",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090732000",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060490",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436460601",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51129224001",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014020",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728302",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436032103",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007730",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436032302",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919012645",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014021",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293084505",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014050",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728305",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007725",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014093",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436032303",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046372",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014024",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407084101",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014060",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728308",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007728",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059690",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436460602",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062190",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014094",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007715",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700044660",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436032301",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007740",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060430",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007700",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002230",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687046801",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007721",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037500",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436460603",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007760",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760092920",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039815",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002290",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037509",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007724",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037590",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407084105",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348082530",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760092990",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039860",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187096240",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037520",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007742",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919012672",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007704",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014015",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046371",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700044690",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099290",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059620",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007750",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099260",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007720",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060400",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062145",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760092960",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877032101",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059630",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007790",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147000",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959007770",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062115",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062160",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062171",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645056354",
      "ndc_label_name": "Ibuprofen TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059660",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002039830",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162046650",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348082540",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135040212",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187096230",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002221",
      "ndc_label_name": "Ibuprofen TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707902",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919012690",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348082515",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011850",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014040",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099230",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099224",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099220",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818308",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046321",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348082520",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267096300",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014042",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099240",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380080707",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099221",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818309",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046360",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54738096202",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707901",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014090",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147001",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162046610",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147004",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831908",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046390",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014010",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707906",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651036201",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147008",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071484503",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147007",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831909",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062172",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700044630",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818302",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037530",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380080706",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707909",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011891",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150080050",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002260",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060409",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818307",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037560",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162046609",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818304",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877029601",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006850",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187096260",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060460",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824402",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760060420",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877029605",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818305",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877029650",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436018202",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147005",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919012660",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006805",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760092930",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877032105",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824401",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708003",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512078010",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877029630",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046315",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005130",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919012630",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877032130",
      "ndc_label_name": "Ibuprofen TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824404",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708009",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003290",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708001",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046345",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335107306",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046330",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071336203",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824407",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818303",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335107305",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818301",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062121",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335107309",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046340",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707903",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871008",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824405",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268905",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818306",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002240",
      "ndc_label_name": "Ibuprofen TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045680",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062130",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708002",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875703",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824408",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038760",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824403",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187096290",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610050592",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062140",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708007",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788911509",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871001",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055060",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824406",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147002",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096792",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099215",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708008",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006810",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871004",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089080",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871009",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011800",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026672",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147003",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831904",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518140902",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875702",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089780",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788911209",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877032150",
      "ndc_label_name": "Ibuprofen TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055621",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147006",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831905",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335107307",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875704",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089792",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150080010",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708006",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018690",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147009",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871002",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335139605",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875707",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089870",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006801",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831901",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020020",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011884",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871005",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268901",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788911206",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090192",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436018201",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831906",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036406",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071412903",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875709",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268903",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788911502",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921018250",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335107303",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831907",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038230",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708005",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788911202",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268904",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005190",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026615",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120606",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871003",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73086021201",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824409",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788911503",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268906",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335139609",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055620",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335139606",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871006",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004703",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831902",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367039605",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015480",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610050580",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020010",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335139607",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875705",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053704",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831903",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69512080090",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015492",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064680",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020090",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268900",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788911203",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005090",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871007",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006803",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027580",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089253",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020093",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268902",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367039601",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509146609",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875701",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003230",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027592",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089292",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036430",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268909",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003215",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509239603",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875706",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71550010090",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038780",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089760",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282071410",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015460",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003260",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090160",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875708",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027560",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045692",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090170",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282071450",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020280",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335100809",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71862000701",
      "ndc_label_name": "Ibuprofen TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788911506",
      "ndc_label_name": "Ibuprofen TABLET 800 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089280",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055080",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026690",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004605",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089880",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335120609",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055630",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518000506",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921018201",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089892",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018660",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004704",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096760",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038792",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020021",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518140900",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026630",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036421",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036460",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425024304",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026671",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045660",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282071430",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005160",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026660",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004701",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282071490",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039302",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018682",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055092",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004602",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268907",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055645",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008903",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008901",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053705",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020015",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064660",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039305",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268908",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020060",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053703",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053702",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005030",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021830",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089260",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804022730",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020260",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036440",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509239606",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804022760",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020292",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036410",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089770",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804022790",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610050560",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036490",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096780",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509146603",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064692",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036420",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055660",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036493",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089060",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282071446",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055690",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057790",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089270",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057730",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020012",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008902",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089753",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057760",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020030",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039303",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089860",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004603",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020040",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004702",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090180",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004705",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036415",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008904",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026640",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509146606",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420057701",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018630",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004601",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004604",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039301",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039304",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053701",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005060",
      "ndc_label_name": "Ibuprofen Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00065804603",
      "ndc_label_name": "ICaps Capsule Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11877001135",
      "ndc_label_name": "ID Now COVID-19 2.0 Test Kit In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11877001126",
      "ndc_label_name": "ID NOW COVID-19 Kit In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598034431",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505290009",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714070401",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378224577",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991037690",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292004303",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292004301",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093762998",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598034490",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629206701",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687019211",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722029690",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651024090",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687088221",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598034479",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832053209",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335047281",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009008690",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268042612",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72819018509",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687019221",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877063390",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407026990",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904690104",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268042611",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001062205",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687088211",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72485020290",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135065890",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59923072390",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001049005",
      "ndc_label_name": "Imatinib Mesylate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135065930",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292004403",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093763056",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378224693",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832053303",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904662104",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714070501",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629206801",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001062304",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268042712",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335047583",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505290103",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598034579",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598034530",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722029730",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72485020330",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72819018603",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687020325",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407027030",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009008730",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268042711",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687020395",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292004401",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651024130",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877063430",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001049104",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598034531",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991037733",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59923072430",
      "ndc_label_name": "Imatinib Mesylate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57962014009",
      "ndc_label_name": "Imbruvica Capsule 140 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57962014012",
      "ndc_label_name": "Imbruvica Capsule 140 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57962042028",
      "ndc_label_name": "Imbruvica Tablet 420 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57962056028",
      "ndc_label_name": "Imbruvica Tablet 560 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781176201",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884005401",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095630",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013301",
      "ndc_label_name": "Imipramine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013301",
      "ndc_label_name": "Imipramine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629220801",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291034501",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013310",
      "ndc_label_name": "Imipramine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884005410",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700070930",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584042510",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029401",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024095",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016901",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629814901",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095672",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029403",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429009501",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095655",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095690",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095600",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016902",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095611",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013310",
      "ndc_label_name": "Imipramine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584042590",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029402",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205080430",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024001",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095660",
      "ndc_label_name": "Imipramine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049295",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291034601",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781176410",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959079130",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884005510",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884005501",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781176401",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440763590",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436202201",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090003400",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436202202",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014414",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436202203",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013410",
      "ndc_label_name": "Imipramine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090314800",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700071030",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024301",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014430",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289014490",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629220901",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584042610",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380017001",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013401",
      "ndc_label_name": "Imipramine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429009601",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024395",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013401",
      "ndc_label_name": "Imipramine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380017002",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095711",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049201",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267026630",
      "ndc_label_name": "Imipramine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013410",
      "ndc_label_name": "Imipramine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425034202",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425034201",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70868081010",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095730",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095772",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584042690",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095700",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425034203",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095790",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095755",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095760",
      "ndc_label_name": "Imipramine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440763690",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584042710",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884005601",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781176601",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289083930",
      "ndc_label_name": "Imipramine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291034701",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013501",
      "ndc_label_name": "Imipramine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024401",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781176610",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049301",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884005610",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380017101",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013501",
      "ndc_label_name": "Imipramine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584042790",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095830",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049395",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125013510",
      "ndc_label_name": "Imipramine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095855",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429009701",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380017102",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095800",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095872",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629221001",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024495",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315013510",
      "ndc_label_name": "Imipramine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095811",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095890",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095860",
      "ndc_label_name": "Imipramine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802036862",
      "ndc_label_name": "Imiquimod CREAM 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802036853",
      "ndc_label_name": "Imiquimod CREAM 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118994101",
      "ndc_label_name": "Imiquimod CREAM 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672414506",
      "ndc_label_name": "Imiquimod CREAM 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802036800",
      "ndc_label_name": "Imiquimod Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168043224",
      "ndc_label_name": "Imiquimod Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335272501",
      "ndc_label_name": "Imiquimod Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168043227",
      "ndc_label_name": "Imiquimod Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462053601",
      "ndc_label_name": "Imiquimod Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672414508",
      "ndc_label_name": "Imiquimod CREAM 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162233202",
      "ndc_label_name": "Imiquimod Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335300001",
      "ndc_label_name": "Imiquimod Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462053670",
      "ndc_label_name": "Imiquimod CREAM 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008424",
      "ndc_label_name": "Imiquimod Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63044015910",
      "ndc_label_name": "Inatal GT TABLET ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "15054104005",
      "ndc_label_name": "Increlex SOLUTION 40 MG/4ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71863021604",
      "ndc_label_name": "Increlex Solution 40 MG/4ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173087310",
      "ndc_label_name": "Incruse Ellipta Aerosol Powder Breath Activated 62.5 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173087306",
      "ndc_label_name": "Incruse Ellipta Aerosol Powder Breath Activated 62.5 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440764060",
      "ndc_label_name": "Indapamide Tablet 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090782800",
      "ndc_label_name": "Indapamide Tablet 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228259796",
      "ndc_label_name": "Indapamide TABLET 1.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228259711",
      "ndc_label_name": "Indapamide TABLET 1.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407002401",
      "ndc_label_name": "Indapamide Tablet 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440764030",
      "ndc_label_name": "Indapamide Tablet 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162176601",
      "ndc_label_name": "Indapamide Tablet 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356022630",
      "ndc_label_name": "Indapamide Tablet 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559051001",
      "ndc_label_name": "Indapamide TABLET 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629195301",
      "ndc_label_name": "Indapamide Tablet 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291034890",
      "ndc_label_name": "Indapamide Tablet 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571087501",
      "ndc_label_name": "Indapamide Tablet 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228257111",
      "ndc_label_name": "Indapamide TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228257196",
      "ndc_label_name": "Indapamide TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291034990",
      "ndc_label_name": "Indapamide Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724706",
      "ndc_label_name": "Indapamide Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090782601",
      "ndc_label_name": "Indapamide Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559051101",
      "ndc_label_name": "Indapamide TABLET 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571087601",
      "ndc_label_name": "Indapamide Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724709",
      "ndc_label_name": "Indapamide Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407002501",
      "ndc_label_name": "Indapamide Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724703",
      "ndc_label_name": "Indapamide Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162176701",
      "ndc_label_name": "Indapamide Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629195401",
      "ndc_label_name": "Indapamide Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788724701",
      "ndc_label_name": "Indapamide Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440765230",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440765220",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440765212",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440765206",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036830",
      "ndc_label_name": "Indomethacin CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440765208",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722054210",
      "ndc_label_name": "Indomethacin CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090282103",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036806",
      "ndc_label_name": "Indomethacin CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440765295",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063077315",
      "ndc_label_name": "Indomethacin CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036815",
      "ndc_label_name": "Indomethacin CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090005407",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440765221",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063036890",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959008040",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090005401",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063077330",
      "ndc_label_name": "Indomethacin CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090005500",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090005207",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090309700",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440765290",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090005201",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919012930",
      "ndc_label_name": "Indomethacin CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268043015",
      "ndc_label_name": "Indomethacin CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999023415",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959008020",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090005403",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959008025",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722054201",
      "ndc_label_name": "Indomethacin CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959008030",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698303",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899301",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999023460",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052620",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090282101",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267011930",
      "ndc_label_name": "Indomethacin CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999023490",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899303",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162129900",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809202",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090005300",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187094820",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959008021",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205021520",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090005203",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462040610",
      "ndc_label_name": "Indomethacin CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162129901",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205021530",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629191301",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899302",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959008090",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420014890",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268043011",
      "ndc_label_name": "Indomethacin CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420014830",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420014814",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052630",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135006718",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420014860",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420014820",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135006790",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187085230",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809203",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462040601",
      "ndc_label_name": "Indomethacin CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865014801",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698302",
      "ndc_label_name": "Indomethacin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298703",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090005003",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063077720",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298701",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356069730",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999010090",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722054301",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090280300",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760091621",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090005100",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063077730",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959008100",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092930",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090005001",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092920",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090302203",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013060",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298700",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999010060",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959008120",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063093020",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090302201",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268043115",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268043111",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048715",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090301400",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090005000",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760029430",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090302200",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959008130",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436398102",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700053730",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048760",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959008121",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010703",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919016421",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760091630",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959008140",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959008190",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760029421",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899401",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013015",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010705",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899402",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462030201",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010707",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013090",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048730",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267012020",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919016430",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010706",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010701",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934018130",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187028230",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135006890",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135006818",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644803",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629191401",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162130001",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010702",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205015930",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267012030",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899403",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405503",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865014901",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267092600",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010704",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462030205",
      "ndc_label_name": "Indomethacin CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811703",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934039530",
      "ndc_label_name": "Indomethacin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11917006307",
      "ndc_label_name": "Infants Ibuprofen SUSPENSION 50 MG/1.25ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802005705",
      "ndc_label_name": "Infants Ibuprofen Suspension 50 MG/1.25ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800005705",
      "ndc_label_name": "Infants Ibuprofen SUSPENSION 50 MG/1.25ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142025510",
      "ndc_label_name": "Infants Ibuprofen Suspension 50 MG/1.25ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205011030",
      "ndc_label_name": "Infants Ibuprofen Suspension 50 MG/1.25ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000029801",
      "ndc_label_name": "Infants Ibuprofen SUSPENSION 50 MG/1.25ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800025510",
      "ndc_label_name": "Infants Ibuprofen SUSPENSION 50 MG/1.25ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373208800",
      "ndc_label_name": "InnoSpire Replacement Filter",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00085460202",
      "ndc_label_name": "Inspirease",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73070020315",
      "ndc_label_name": "Insulin Asp Prot & Asp FlexPen Suspension Pen-Injector (70-30) 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73070020310",
      "ndc_label_name": "Insulin Asp Prot & Asp FlexPen Suspension Pen-Injector (70-30) 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73070020011",
      "ndc_label_name": "Insulin Aspart Prot & Aspart Suspension (70-30) 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502039380",
      "ndc_label_name": "Insulin Glargine-yfgn Solution 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83257001411",
      "ndc_label_name": "Insulin Glargine-yfgn Solution 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72572042205",
      "ndc_label_name": "Insulin Glargine-yfgn Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72572042405",
      "ndc_label_name": "Insulin Glargine-yfgn Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502039475",
      "ndc_label_name": "Insulin Glargine-yfgn Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502039471",
      "ndc_label_name": "Insulin Glargine-yfgn Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72572042401",
      "ndc_label_name": "Insulin Glargine-yfgn Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83257001531",
      "ndc_label_name": "Insulin Glargine-yfgn Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72572042201",
      "ndc_label_name": "Insulin Glargine-yfgn Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83257001532",
      "ndc_label_name": "Insulin Glargine-yfgn Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002823301",
      "ndc_label_name": "Insulin Lispro Prot & Lispro Suspension Pen-Injector (75-25) 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002823305",
      "ndc_label_name": "Insulin Lispro Prot & Lispro Suspension Pen-Injector (75-25) 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59676057201",
      "ndc_label_name": "Intelence TABLET 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49614031726",
      "ndc_label_name": "Intense Cough Reliever Liquid 20-300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49614030726",
      "ndc_label_name": "Intense Cough Reliever Liquid 30-200 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00085113301",
      "ndc_label_name": "Intron A Solution 10000000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00085435001",
      "ndc_label_name": "Intron A Solution Reconstituted 10000000 UNIT Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50458061101",
      "ndc_label_name": "Invega Hafyera Suspension Prefilled Syringe 1092 MG/3.5ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458061201",
      "ndc_label_name": "Invega Hafyera Suspension Prefilled Syringe 1560 MG/5ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458056201",
      "ndc_label_name": "Invega Sustenna Suspension Prefilled Syringe 117 MG/0.75ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458056301",
      "ndc_label_name": "Invega Sustenna Suspension Prefilled Syringe 156 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458056401",
      "ndc_label_name": "Invega Sustenna Suspension Prefilled Syringe 234 MG/1.5ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458056001",
      "ndc_label_name": "Invega Sustenna Suspension Prefilled Syringe 39 MG/0.25ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458056101",
      "ndc_label_name": "Invega Sustenna Suspension Prefilled Syringe 78 MG/0.5ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458060601",
      "ndc_label_name": "Invega Trinza Suspension Prefilled Syringe 273 MG/0.88ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458060701",
      "ndc_label_name": "Invega Trinza Suspension Prefilled Syringe 410 MG/1.32ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458060801",
      "ndc_label_name": "Invega Trinza Suspension Prefilled Syringe 546 MG/1.75ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458060901",
      "ndc_label_name": "Invega Trinza Suspension Prefilled Syringe 819 MG/2.63ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00004024451",
      "ndc_label_name": "Invirase Tablet 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487980130",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.02 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378797031",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378797093",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.02 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378797091",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.02 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204010025",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090066800",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980064003",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378797055",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.02 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090637300",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378797052",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.02 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335070649",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335070652",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204010060",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487980160",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.02 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862090530",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487980101",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.02 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980064006",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781715729",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.02 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862090560",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135083084",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781715764",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.02 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487980125",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.02 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980064002",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204010001",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204010030",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781715786",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.02 % INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356012430",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335070654",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256600",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154435105",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687039479",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687039483",
      "ndc_label_name": "Ipratropium Bromide Solution 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862090525",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.02 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162214303",
      "ndc_label_name": "Ipratropium Bromide Solution 0.03 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054004544",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.03 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999038930",
      "ndc_label_name": "Ipratropium Bromide Solution 0.03 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208039830",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.03 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748033601",
      "ndc_label_name": "Ipratropium Bromide Solution 0.03 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714052601",
      "ndc_label_name": "Ipratropium Bromide Solution 0.03 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888014938",
      "ndc_label_name": "Ipratropium Bromide Solution 0.03 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238201603",
      "ndc_label_name": "Ipratropium Bromide Solution 0.03 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505082601",
      "ndc_label_name": "Ipratropium Bromide Solution 0.03 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888014837",
      "ndc_label_name": "Ipratropium Bromide Solution 0.06 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238201702",
      "ndc_label_name": "Ipratropium Bromide Solution 0.06 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054004641",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.06 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090596800",
      "ndc_label_name": "Ipratropium Bromide Solution 0.06 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714052701",
      "ndc_label_name": "Ipratropium Bromide Solution 0.06 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505082701",
      "ndc_label_name": "Ipratropium Bromide Solution 0.06 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208039915",
      "ndc_label_name": "Ipratropium Bromide SOLUTION 0.06 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748033701",
      "ndc_label_name": "Ipratropium Bromide Solution 0.06 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162214402",
      "ndc_label_name": "Ipratropium Bromide Solution 0.06 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090138200",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090166900",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205005130",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487020160",
      "ndc_label_name": "Ipratropium-Albuterol SOLUTION 0.5-2.5 (3) MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256700",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378967130",
      "ndc_label_name": "Ipratropium-Albuterol SOLUTION 0.5-2.5 (3) MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378967193",
      "ndc_label_name": "Ipratropium-Albuterol SOLUTION 0.5-2.5 (3) MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980064503",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084053",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090410300",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487020101",
      "ndc_label_name": "Ipratropium-Albuterol SOLUTION 0.5-2.5 (3) MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205005115",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429097560",
      "ndc_label_name": "Ipratropium-Albuterol SOLUTION 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378967131",
      "ndc_label_name": "Ipratropium-Albuterol SOLUTION 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335075649",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205072615",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205005105",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135083184",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335075652",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378967160",
      "ndc_label_name": "Ipratropium-Albuterol SOLUTION 0.5-2.5 (3) MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687040583",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204060030",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090628800",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00487020103",
      "ndc_label_name": "Ipratropium-Albuterol SOLUTION 0.5-2.5 (3) MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204060001",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204060060",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429097530",
      "ndc_label_name": "Ipratropium-Albuterol SOLUTION 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788810303",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840803",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097017353",
      "ndc_label_name": "Ipratropium-Albuterol SOLUTION 0.5-2.5 (3) MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687040579",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084034",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204060012",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084087",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980064506",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097017364",
      "ndc_label_name": "Ipratropium-Albuterol SOLUTION 0.5-2.5 (3) MG/3ML INHALATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097084064",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76204060005",
      "ndc_label_name": "Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300021319",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291094190",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42658012204",
      "ndc_label_name": "Irbesartan TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300021313",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00955104190",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268044115",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547037550",
      "ndc_label_name": "Irbesartan TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342004807",
      "ndc_label_name": "Irbesartan TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722073005",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746044830",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862063805",
      "ndc_label_name": "Irbesartan TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090128400",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722016110",
      "ndc_label_name": "Irbesartan TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008008430",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090128401",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004290",
      "ndc_label_name": "Irbesartan TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722073030",
      "ndc_label_name": "Irbesartan TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004230",
      "ndc_label_name": "Irbesartan TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335042301",
      "ndc_label_name": "Irbesartan TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135097730",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342004810",
      "ndc_label_name": "Irbesartan TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862063890",
      "ndc_label_name": "Irbesartan TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187073730",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205008230",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722073090",
      "ndc_label_name": "Irbesartan TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335042303",
      "ndc_label_name": "Irbesartan TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162235503",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335042302",
      "ndc_label_name": "Irbesartan TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42658012201",
      "ndc_label_name": "Irbesartan TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162235403",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187075730",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547037503",
      "ndc_label_name": "Irbesartan TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603067101",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324400",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862063830",
      "ndc_label_name": "Irbesartan TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547037509",
      "ndc_label_name": "Irbesartan TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324401",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746044890",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268044111",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867009",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135097790",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162235409",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004271",
      "ndc_label_name": "Irbesartan TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189020590",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205045230",
      "ndc_label_name": "Irbesartan Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547037609",
      "ndc_label_name": "Irbesartan TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00955104290",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300021413",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326900",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547037603",
      "ndc_label_name": "Irbesartan TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342004907",
      "ndc_label_name": "Irbesartan TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342004910",
      "ndc_label_name": "Irbesartan TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722073190",
      "ndc_label_name": "Irbesartan TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090201701",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722016205",
      "ndc_label_name": "Irbesartan TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300021419",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090451901",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326901",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291094290",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919079330",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090201700",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090297800",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547037650",
      "ndc_label_name": "Irbesartan TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722073130",
      "ndc_label_name": "Irbesartan TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090693800",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268044215",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090451900",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862063930",
      "ndc_label_name": "Irbesartan TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090343102",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090343101",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189027090",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42658012301",
      "ndc_label_name": "Irbesartan TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004390",
      "ndc_label_name": "Irbesartan TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135097830",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090505501",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42658012304",
      "ndc_label_name": "Irbesartan TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862063905",
      "ndc_label_name": "Irbesartan TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090762200",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603067201",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326902",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862063990",
      "ndc_label_name": "Irbesartan TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268044211",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746044990",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746044930",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603067202",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135097890",
      "ndc_label_name": "Irbesartan Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004371",
      "ndc_label_name": "Irbesartan TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004330",
      "ndc_label_name": "Irbesartan TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300021213",
      "ndc_label_name": "Irbesartan Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268044015",
      "ndc_label_name": "Irbesartan Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722072930",
      "ndc_label_name": "Irbesartan TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342004710",
      "ndc_label_name": "Irbesartan TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00955104090",
      "ndc_label_name": "Irbesartan Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722072990",
      "ndc_label_name": "Irbesartan TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205037930",
      "ndc_label_name": "Irbesartan Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300021219",
      "ndc_label_name": "Irbesartan Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722016005",
      "ndc_label_name": "Irbesartan TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004190",
      "ndc_label_name": "Irbesartan TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42658012104",
      "ndc_label_name": "Irbesartan TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291094090",
      "ndc_label_name": "Irbesartan Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342004707",
      "ndc_label_name": "Irbesartan TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862063790",
      "ndc_label_name": "Irbesartan TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547037450",
      "ndc_label_name": "Irbesartan TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42658012101",
      "ndc_label_name": "Irbesartan TABLET 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135097690",
      "ndc_label_name": "Irbesartan Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205040430",
      "ndc_label_name": "Irbesartan Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746044790",
      "ndc_label_name": "Irbesartan Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189020190",
      "ndc_label_name": "Irbesartan Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746044730",
      "ndc_label_name": "Irbesartan Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547037403",
      "ndc_label_name": "Irbesartan TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004130",
      "ndc_label_name": "Irbesartan TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547037409",
      "ndc_label_name": "Irbesartan TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135097630",
      "ndc_label_name": "Irbesartan Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268044011",
      "ndc_label_name": "Irbesartan Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862063730",
      "ndc_label_name": "Irbesartan TABLET 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603067001",
      "ndc_label_name": "Irbesartan Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008008530",
      "ndc_label_name": "Irbesartan Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00955104590",
      "ndc_label_name": "Irbesartan-hydroCHLOROthiazide Tablet 150-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093823856",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 150-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006330",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide Tablet 150-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054025413",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 150-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291034290",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide Tablet 150-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033003",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide Tablet 150-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093823898",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 150-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033009",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide Tablet 150-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005707",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 150-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054025422",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 150-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162103509",
      "ndc_label_name": "Irbesartan-hydroCHLOROthiazide Tablet 150-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332005130",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 150-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162231703",
      "ndc_label_name": "Irbesartan-hydroCHLOROthiazide Tablet 150-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005710",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 150-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332005190",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 150-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162231709",
      "ndc_label_name": "Irbesartan-hydroCHLOROthiazide Tablet 150-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335109702",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide Tablet 150-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093823256",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 300-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054025513",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 300-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332005230",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 300-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862063030",
      "ndc_label_name": "Irbesartan-hydroCHLOROthiazide Tablet 300-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332005290",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 300-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054025522",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 300-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093823298",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 300-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005807",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 300-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00955104690",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide Tablet 300-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291034390",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide Tablet 300-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005810",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide TABLET 300-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033109",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide Tablet 300-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033103",
      "ndc_label_name": "Irbesartan-Hydrochlorothiazide Tablet 300-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31604004252",
      "ndc_label_name": "Iron (Ferrous Sulfate) Tablet 325 (65 Fe) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00006308001",
      "ndc_label_name": "Isentress HD TABLET 600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006360361",
      "ndc_label_name": "Isentress PACKET 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090108500",
      "ndc_label_name": "Isentress Tablet 400 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006022761",
      "ndc_label_name": "Isentress TABLET 400 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090108502",
      "ndc_label_name": "Isentress Tablet 400 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071211306",
      "ndc_label_name": "Isentress Tablet 400 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070602",
      "ndc_label_name": "Isentress Tablet 400 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090108501",
      "ndc_label_name": "Isentress Tablet 400 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070606",
      "ndc_label_name": "Isentress Tablet 400 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006047761",
      "ndc_label_name": "Isentress TABLET CHEWABLE 100 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006047361",
      "ndc_label_name": "Isentress TABLET CHEWABLE 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "46287000901",
      "ndc_label_name": "Isoniazid Syrup 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135055047",
      "ndc_label_name": "Isoniazid Syrup 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440765760",
      "ndc_label_name": "Isoniazid Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090041000",
      "ndc_label_name": "Isoniazid Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440765730",
      "ndc_label_name": "Isoniazid Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267012330",
      "ndc_label_name": "Isoniazid Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950021610",
      "ndc_label_name": "Isoniazid Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555006602",
      "ndc_label_name": "Isoniazid Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135080401",
      "ndc_label_name": "Isoniazid Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81665010710",
      "ndc_label_name": "Isoniazid Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162244401",
      "ndc_label_name": "Isoniazid Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063046330",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440765530",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135080501",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079008320",
      "ndc_label_name": "Isoniazid TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090037003",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440165530",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555007101",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555007102",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014530",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135058401",
      "ndc_label_name": "Isoniazid TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090766003",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014581",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014550",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440765560",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999070300",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135080530",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002029230",
      "ndc_label_name": "Isoniazid TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348081530",
      "ndc_label_name": "Isoniazid TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014560",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071132600",
      "ndc_label_name": "Isoniazid TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055301",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135058430",
      "ndc_label_name": "Isoniazid TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079008301",
      "ndc_label_name": "Isoniazid TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014500",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950021703",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162244503",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002029200",
      "ndc_label_name": "Isoniazid TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162244501",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055311",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039530",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81665010830",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348081536",
      "ndc_label_name": "Isoniazid TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267012460",
      "ndc_label_name": "Isoniazid TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81665010810",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950021710",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135070990",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335276001",
      "ndc_label_name": "Isoniazid Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143177101",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407014810",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739056910",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440766694",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440766690",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013992",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781155610",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268044811",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440766640",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088490",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013960",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440766695",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440766691",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268044815",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884002101",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001037400",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904661961",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008201",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884002110",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781155601",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999039660",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629257301",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008200",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710114901",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084008201",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714000801",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084008211",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011790",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407014801",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629257302",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714000901",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904662061",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014192",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710115001",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440766795",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440766796",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440766790",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143177201",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268044915",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014160",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407014910",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804010890",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407014901",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804010830",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884002210",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440766794",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084008301",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959096618",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001037500",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781169501",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084008311",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289017460",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781169510",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739036710",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884002201",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008301",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268044911",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008300",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008401",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001056200",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710115101",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714001001",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008400",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291035001",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884000901",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884000910",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268044715",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781163510",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884002010",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781163501",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884002001",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143176901",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714000701",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407014710",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268044711",
      "ndc_label_name": "Isosorbide Dinitrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710114801",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682019301",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407014701",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008100",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001037300",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008101",
      "ndc_label_name": "Isosorbide Dinitrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799096001",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010670",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353091705",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651054101",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610032105",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010659",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010601",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155062801",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268045311",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268045315",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742017701",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135058890",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407021001",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065201",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175012937",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010401",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090568601",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155051905",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799095802",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155051901",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904644961",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999076090",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010410",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090568602",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268045111",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090078702",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651053905",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799095801",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255402",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255400",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090078701",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268045115",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742017501",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090568600",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544023609",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544023656",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090679800",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255401",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090404701",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651053901",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020801",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090749600",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544023660",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059101",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020805",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090404700",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090404702",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544023630",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175012846",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742017505",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059111",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610078830",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687078311",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090679801",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090679802",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065001",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033830",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154478500",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065005",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610078860",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090703800",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919075830",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687078301",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033860",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175012837",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135058690",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071068030",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175012841",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544023699",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082560",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799095901",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155017801",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666101",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207701",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010501",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090196301",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904645061",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090196300",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799095902",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090400901",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629182301",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666100",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155017805",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207700",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668010510",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742017601",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063031330",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666102",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090400900",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175011937",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268045211",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207702",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079411",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544022430",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090196302",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268045215",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175011943",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544022445",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742017605",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090400902",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544022460",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033730",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135058790",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020905",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071034130",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544022480",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651054001",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407020901",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175011946",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335003704",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544022481",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651054005",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065101",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033745",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059201",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079401",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335003702",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033780",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335003703",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175011941",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077260",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077230",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544022456",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077245",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544022482",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544022499",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335003701",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059211",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335219201",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065105",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033760",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077280",
      "ndc_label_name": "Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162244201",
      "ndc_label_name": "Isosorbide Mononitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175010601",
      "ndc_label_name": "Isosorbide Mononitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228263111",
      "ndc_label_name": "Isosorbide Mononitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81665010210",
      "ndc_label_name": "Isosorbide Mononitrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162244301",
      "ndc_label_name": "Isosorbide Mononitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228262011",
      "ndc_label_name": "Isosorbide Mononitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81665010310",
      "ndc_label_name": "Isosorbide Mononitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187090030",
      "ndc_label_name": "Isosorbide Mononitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175010701",
      "ndc_label_name": "Isosorbide Mononitrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245057089",
      "ndc_label_name": "ISOtretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832830130",
      "ndc_label_name": "ISOtretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591243315",
      "ndc_label_name": "ISOtretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00245057001",
      "ndc_label_name": "ISOtretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591243345",
      "ndc_label_name": "ISOtretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651063110",
      "ndc_label_name": "ISOtretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832830189",
      "ndc_label_name": "ISOtretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664002098",
      "ndc_label_name": "ISOtretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308078130",
      "ndc_label_name": "ISOtretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651063103",
      "ndc_label_name": "ISOtretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238117403",
      "ndc_label_name": "ISOtretinoin CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664002097",
      "ndc_label_name": "ISOtretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238117401",
      "ndc_label_name": "ISOtretinoin CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308057001",
      "ndc_label_name": "ISOtretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308057030",
      "ndc_label_name": "ISOtretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710102208",
      "ndc_label_name": "ISOtretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308078101",
      "ndc_label_name": "ISOtretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00245057101",
      "ndc_label_name": "ISOtretinoin Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591243445",
      "ndc_label_name": "ISOtretinoin Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651063203",
      "ndc_label_name": "ISOtretinoin Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591243415",
      "ndc_label_name": "ISOtretinoin Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308078230",
      "ndc_label_name": "ISOtretinoin Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00245057189",
      "ndc_label_name": "ISOtretinoin Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308057130",
      "ndc_label_name": "ISOtretinoin Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664002197",
      "ndc_label_name": "ISOtretinoin Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308057101",
      "ndc_label_name": "ISOtretinoin Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651063210",
      "ndc_label_name": "ISOtretinoin Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308078201",
      "ndc_label_name": "ISOtretinoin Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832830230",
      "ndc_label_name": "ISOtretinoin Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710102308",
      "ndc_label_name": "ISOtretinoin Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238117501",
      "ndc_label_name": "ISOtretinoin CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238117503",
      "ndc_label_name": "ISOtretinoin CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664002198",
      "ndc_label_name": "ISOtretinoin Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832830289",
      "ndc_label_name": "ISOtretinoin Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591243515",
      "ndc_label_name": "ISOtretinoin Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00245057301",
      "ndc_label_name": "ISOtretinoin Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00245057389",
      "ndc_label_name": "ISOtretinoin Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591243545",
      "ndc_label_name": "ISOtretinoin Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308057301",
      "ndc_label_name": "ISOtretinoin Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832830389",
      "ndc_label_name": "ISOtretinoin Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832830330",
      "ndc_label_name": "ISOtretinoin Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664002397",
      "ndc_label_name": "ISOtretinoin Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238101701",
      "ndc_label_name": "ISOtretinoin CAPSULE 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308078301",
      "ndc_label_name": "ISOtretinoin Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651063410",
      "ndc_label_name": "ISOtretinoin Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664002398",
      "ndc_label_name": "ISOtretinoin Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308057330",
      "ndc_label_name": "ISOtretinoin Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308078330",
      "ndc_label_name": "ISOtretinoin Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238101703",
      "ndc_label_name": "ISOtretinoin CAPSULE 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651063403",
      "ndc_label_name": "ISOtretinoin Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710102408",
      "ndc_label_name": "ISOtretinoin Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591243645",
      "ndc_label_name": "ISOtretinoin Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651063603",
      "ndc_label_name": "ISOtretinoin Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00245057589",
      "ndc_label_name": "ISOtretinoin Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308057501",
      "ndc_label_name": "ISOtretinoin Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591243615",
      "ndc_label_name": "ISOtretinoin Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00245057501",
      "ndc_label_name": "ISOtretinoin Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664002598",
      "ndc_label_name": "ISOtretinoin Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832830489",
      "ndc_label_name": "ISOtretinoin Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664002597",
      "ndc_label_name": "ISOtretinoin Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308078430",
      "ndc_label_name": "ISOtretinoin Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832830430",
      "ndc_label_name": "ISOtretinoin Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238117603",
      "ndc_label_name": "ISOtretinoin CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308057530",
      "ndc_label_name": "ISOtretinoin Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238117601",
      "ndc_label_name": "ISOtretinoin CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651063610",
      "ndc_label_name": "ISOtretinoin Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308078401",
      "ndc_label_name": "ISOtretinoin Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710102508",
      "ndc_label_name": "ISOtretinoin Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10147170003",
      "ndc_label_name": "Itraconazole CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378510093",
      "ndc_label_name": "Itraconazole Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571024503",
      "ndc_label_name": "Itraconazole Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268045011",
      "ndc_label_name": "Itraconazole Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687029925",
      "ndc_label_name": "Itraconazole Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714074302",
      "ndc_label_name": "Itraconazole CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687029995",
      "ndc_label_name": "Itraconazole Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877045430",
      "ndc_label_name": "Itraconazole CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884023911",
      "ndc_label_name": "Itraconazole Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668046330",
      "ndc_label_name": "Itraconazole Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027110",
      "ndc_label_name": "Itraconazole Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268045012",
      "ndc_label_name": "Itraconazole Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020430",
      "ndc_label_name": "Itraconazole CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332020404",
      "ndc_label_name": "Itraconazole CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162063003",
      "ndc_label_name": "Itraconazole CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799080601",
      "ndc_label_name": "Ivermectin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888020666",
      "ndc_label_name": "Ivermectin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907016710",
      "ndc_label_name": "Ivermectin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907016721",
      "ndc_label_name": "Ivermectin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090558700",
      "ndc_label_name": "Ivermectin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50881001060",
      "ndc_label_name": "Jakafi TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50881001560",
      "ndc_label_name": "Jakafi TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50881002060",
      "ndc_label_name": "Jakafi TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50881002560",
      "ndc_label_name": "Jakafi TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50881000560",
      "ndc_label_name": "Jakafi TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093312228",
      "ndc_label_name": "Jinteli TABLET 1-5 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093312298",
      "ndc_label_name": "Jinteli TABLET 1-5 MG-MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093312242",
      "ndc_label_name": "Jinteli TABLET 1-5 MG-MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49702024213",
      "ndc_label_name": "Juluca TABLET 50-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00486112501",
      "ndc_label_name": "K-Phos-Neutral Tablet 155-852-130 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00486112505",
      "ndc_label_name": "K-Phos-Neutral Tablet 155-852-130 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074327813",
      "ndc_label_name": "K-Tab Tablet Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074327819",
      "ndc_label_name": "K-Tab Tablet Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074302313",
      "ndc_label_name": "K-Tab Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074395646",
      "ndc_label_name": "Kaletra Solution 400-100 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074052260",
      "ndc_label_name": "Kaletra Tablet 100-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356011160",
      "ndc_label_name": "Kaletra Tablet 100-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074157521",
      "ndc_label_name": "Kaletra Tablet 100-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959096812",
      "ndc_label_name": "Kaletra Tablet 100-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074300860",
      "ndc_label_name": "Kaletra Tablet 100-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356011201",
      "ndc_label_name": "Kaletra Tablet 200-50 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356011230",
      "ndc_label_name": "Kaletra Tablet 200-50 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071074812",
      "ndc_label_name": "Kaletra Tablet 200-50 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074260521",
      "ndc_label_name": "Kaletra Tablet 200-50 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074401412",
      "ndc_label_name": "Kaletra Tablet 200-50 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074679922",
      "ndc_label_name": "Kaletra Tablet 200-50 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289094712",
      "ndc_label_name": "Kaletra Tablet 200-50 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51167060001",
      "ndc_label_name": "Kalydeco Packet 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51167030001",
      "ndc_label_name": "Kalydeco PACKET 50 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51167040001",
      "ndc_label_name": "Kalydeco PACKET 75 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51167020001",
      "ndc_label_name": "Kalydeco Tablet 150 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52652500101",
      "ndc_label_name": "Katerzia Suspension 1 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093807316",
      "ndc_label_name": "Kelnor 1/50 Tablet 1-50 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093807328",
      "ndc_label_name": "Kelnor 1/50 Tablet 1-50 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08881992110",
      "ndc_label_name": "Kendall Sodium Chloride Flush SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21922002504",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095503",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168009960",
      "ndc_label_name": "Ketoconazole CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093321992",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168009915",
      "ndc_label_name": "Ketoconazole CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093321930",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093321915",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606900",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922002507",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922002505",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320700",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168009930",
      "ndc_label_name": "Ketoconazole CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095502",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090167500",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090072000",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959049730",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999074815",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526500",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090604600",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714095501",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999074830",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959049760",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090329900",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077415",
      "ndc_label_name": "Ketoconazole CREAM 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407027915",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407027960",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407027930",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090152400",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672129801",
      "ndc_label_name": "Ketoconazole CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118003005",
      "ndc_label_name": "Ketoconazole CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775501",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077430",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629881901",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959049715",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002081563",
      "ndc_label_name": "Ketoconazole CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672129802",
      "ndc_label_name": "Ketoconazole CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629882001",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71085000860",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788991503",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672129803",
      "ndc_label_name": "Ketoconazole CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071170903",
      "ndc_label_name": "Ketoconazole CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775503",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002081566",
      "ndc_label_name": "Ketoconazole CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042230",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118003003",
      "ndc_label_name": "Ketoconazole CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804009115",
      "ndc_label_name": "Ketoconazole Cream 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118003006",
      "ndc_label_name": "Ketoconazole CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084115",
      "ndc_label_name": "Ketoconazole CREAM 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713059204",
      "ndc_label_name": "Ketoconazole Shampoo 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578015612",
      "ndc_label_name": "Ketoconazole Shampoo 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090122000",
      "ndc_label_name": "Ketoconazole Shampoo 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629867501",
      "ndc_label_name": "Ketoconazole Shampoo 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090328800",
      "ndc_label_name": "Ketoconazole Shampoo 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63646001004",
      "ndc_label_name": "Ketoconazole Shampoo 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335283901",
      "ndc_label_name": "Ketoconazole Shampoo 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802046564",
      "ndc_label_name": "Ketoconazole SHAMPOO 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090753800",
      "ndc_label_name": "Ketoconazole Shampoo 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886801",
      "ndc_label_name": "Ketoconazole Shampoo 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118993901",
      "ndc_label_name": "Ketoconazole SHAMPOO 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954066210",
      "ndc_label_name": "Ketoconazole Shampoo 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825701",
      "ndc_label_name": "Ketoconazole Shampoo 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603087801",
      "ndc_label_name": "Ketoconazole Shampoo 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205010572",
      "ndc_label_name": "Ketoconazole Shampoo 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162140902",
      "ndc_label_name": "Ketoconazole Shampoo 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573043330",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440765930",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429002001",
      "ndc_label_name": "Ketoconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069930",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440765920",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573043302",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069900",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999030120",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090614201",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005230",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335043906",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069960",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063088230",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672402601",
      "ndc_label_name": "Ketoconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069920",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380082706",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189018007",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672402606",
      "ndc_label_name": "Ketoconazole TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042807",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069902",
      "ndc_label_name": "Ketoconazole Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00276050610",
      "ndc_label_name": "Ketoprofen Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85477011101",
      "ndc_label_name": "Ketoprofen Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155002201",
      "ndc_label_name": "Ketoprofen Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61314012610",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478020910",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571013725",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090274600",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854905",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478020919",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090276200",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478020911",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162238402",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335022090",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090114200",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788738405",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61314012605",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571013726",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65145013901",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505100302",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65145014001",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505100301",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162238404",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029605",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315032205",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840005",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189033505",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077705",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512079005",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315032210",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512079010",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189005405",
      "ndc_label_name": "Ketorolac Tromethamine Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00409379325",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021070001",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641604101",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409379301",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641604125",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332059925",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722030501",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338006910",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154936605",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 15 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462075501",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016100",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722030525",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332059901",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016116",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 15 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722030510",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409379319",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016101",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 15 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860070002",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090560900",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572035410",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016112",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 15 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145014601",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016121",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090680700",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084225",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572035401",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084201",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603015325",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462075525",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016141",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860070001",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145014625",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603015301",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860070041",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611071925",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266023401",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266023425",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045010710",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 15 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611071901",
      "ndc_label_name": "Ketorolac Tromethamine Solution 15 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090249900",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332060025",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338007225",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722030601",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641604225",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 30 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409379525",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409379519",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021070101",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090336400",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016212",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 30 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409379501",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722030625",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090542801",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090336401",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016223",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090326101",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462075625",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084301",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641604201",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 30 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090463500",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016200",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572035501",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016243",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090542800",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572035525",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090463501",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332060001",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154012005",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016216",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 30 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145014525",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016201",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 30 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860070141",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045010410",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 30 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205011601",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69374099031",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611072201",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145014501",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860070103",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462075601",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266011825",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084325",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603016101",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860070101",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603016125",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266011801",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611072225",
      "ndc_label_name": "Ketorolac Tromethamine Solution 30 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090339700",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722030702",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409379619",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090071000",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409379601",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641604325",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641604301",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409379625",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860070104",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090132801",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090339701",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090132800",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016245",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016202",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021070102",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487623201",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084425",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090677201",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090677200",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016203",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266011901",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016214",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722030725",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332060125",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860070102",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145014701",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332060102",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016225",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603017225",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462075702",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016226",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462075725",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860070142",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084401",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145014725",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611072525",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189058301",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045010520",
      "ndc_label_name": "Ketorolac Tromethamine SOLUTION 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266011925",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603017201",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72611072501",
      "ndc_label_name": "Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440767208",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767204",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093031401",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241031601",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767215",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378113401",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598013901",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356069610",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722068601",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090780800",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904730304",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573045002",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767220",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356069660",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090626500",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356069620",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999013010",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090780803",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999013015",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291035801",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090415",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090410",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090726500",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090420",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051208",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407067701",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090626503",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051260",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090430",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090060105",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090763800",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090060100",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051212",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051215",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090726503",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135081160",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999013021",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289032810",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051210",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090060103",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051220",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051230",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090745303",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267041820",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999013030",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629297403",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002069920",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090763803",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289032820",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051240",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769500",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788814902",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090745300",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870102",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289032815",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436619002",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013810",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002069910",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769503",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934002915",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436619003",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788889102",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687010421",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760031420",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012810",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760066820",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051209",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963905",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002069930",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315026001",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013820",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760070420",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629297402",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012820",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051214",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013903",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289032812",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543038810",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629297401",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013830",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629928501",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629248801",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002069915",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048904",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289032830",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69784060101",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629297407",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012812",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335213602",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267041860",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013815",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804024820",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687010411",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963901",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812002",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629297404",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335244407",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452027520",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292065001",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629297405",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012815",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963903",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518004804",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710171001",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189037120",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963906",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335213607",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055510",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629297406",
      "ndc_label_name": "Ketorolac Tromethamine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055515",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963902",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789043701",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789043710",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013902",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963908",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425026701",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518004805",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425026704",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189037110",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048903",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048905",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804024815",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189037130",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008000510",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518425500",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013901",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963907",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425026703",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189037115",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048902",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055530",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789043720",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425026702",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425026705",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048901",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008000520",
      "ndc_label_name": "Ketorolac Tromethamine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00193288021",
      "ndc_label_name": "Ketostix STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00193288050",
      "ndc_label_name": "Ketostix STRIP IN VITRO",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17478071710",
      "ndc_label_name": "Ketotifen Fumarate Solution 0.025 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090290000",
      "ndc_label_name": "Ketotifen Fumarate Solution 0.035 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788871505",
      "ndc_label_name": "Ketotifen Fumarate Solution 0.035 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788408405",
      "ndc_label_name": "Ketotifen Fumarate Solution 0.035 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011405",
      "ndc_label_name": "Ketotifen Fumarate Solution 0.035 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189046105",
      "ndc_label_name": "Ketotifen Fumarate Solution 0.035 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959085805",
      "ndc_label_name": "Ketotifen Fumarate Solution 0.035 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090725300",
      "ndc_label_name": "Ketotifen Fumarate Solution 0.035 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "17478071710",
      "ndc_label_name": "Ketotifen Fumarate Solution 0.035 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "76385010617",
      "ndc_label_name": "Ketotifen Fumarate Solution 0.035 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60505621501",
      "ndc_label_name": "Ketotifen Fumarate Solution 0.035 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189021205",
      "ndc_label_name": "Ketotifen Fumarate Solution 0.035 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72485061710",
      "ndc_label_name": "Ketotifen Fumarate Solution 0.035 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205011505",
      "ndc_label_name": "Ketotifen Fumarate Solution 0.035 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00024592001",
      "ndc_label_name": "Kevzara Solution Auto-Injector 150 MG/1.14ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00024592201",
      "ndc_label_name": "Kevzara Solution Auto-Injector 200 MG/1.14ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353099080",
      "ndc_label_name": "Klor-Con M10 Tablet Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245531701",
      "ndc_label_name": "Klor-Con M10 Tablet Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245531711",
      "ndc_label_name": "Klor-Con M10 Tablet Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245531710",
      "ndc_label_name": "Klor-Con M10 Tablet Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245531789",
      "ndc_label_name": "Klor-Con M10 Tablet Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099060",
      "ndc_label_name": "Klor-Con M10 Tablet Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245531790",
      "ndc_label_name": "Klor-Con M10 Tablet Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245531990",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245531911",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098830",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098845",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098853",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098860",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245531901",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245531989",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098815",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098894",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245531910",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098880",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245531915",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098870",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098892",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098873",
      "ndc_label_name": "Klor-Con M20 Tablet Extended Release 20 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245532601",
      "ndc_label_name": "Klor-Con/EF Tablet Effervescent 25 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245532630",
      "ndc_label_name": "Klor-Con/EF Tablet Effervescent 25 MEQ Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00026378555",
      "ndc_label_name": "Kogenate FS Kit 1000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00026378225",
      "ndc_label_name": "Kogenate FS Kit 250 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00026378335",
      "ndc_label_name": "Kogenate FS Kit 500 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00224180124",
      "ndc_label_name": "Konsyl Daily Fiber Packet 100 % Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00224185280",
      "ndc_label_name": "Konsyl Daily Fiber Powder 28.3 % Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00026382425",
      "ndc_label_name": "Kovaltry Solution Reconstituted 1000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00026482401",
      "ndc_label_name": "Kovaltry Solution Reconstituted 1000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00026382650",
      "ndc_label_name": "Kovaltry Solution Reconstituted 2000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00026482601",
      "ndc_label_name": "Kovaltry Solution Reconstituted 2000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00026482101",
      "ndc_label_name": "Kovaltry Solution Reconstituted 250 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00026382125",
      "ndc_label_name": "Kovaltry Solution Reconstituted 250 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00026382850",
      "ndc_label_name": "Kovaltry Solution Reconstituted 3000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00026482801",
      "ndc_label_name": "Kovaltry Solution Reconstituted 3000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00026382225",
      "ndc_label_name": "Kovaltry Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00026482201",
      "ndc_label_name": "Kovaltry Solution Reconstituted 500 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58487000331",
      "ndc_label_name": "KPN Prenatal TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58487000332",
      "ndc_label_name": "KPN Prenatal TABLET 0.1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50419042401",
      "ndc_label_name": "Kyleena INTRAUTERINE DEVICE 19.5 MG INTRAUTERINE",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00185001005",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904710961",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064101",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185001001",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155072305",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591060501",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674101",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135071101",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767860",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904745161",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135071105",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591060505",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090116100",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155072301",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090678500",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781055205",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760062890",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884012201",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781055201",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090116101",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090414900",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090414901",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407061405",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884012205",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629116201",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657060201",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090745701",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629889801",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674100",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090745700",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71247012601",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090745800",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382079801",
      "ndc_label_name": "Labetalol HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657060250",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043901",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71247012605",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407061401",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629116101",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001038100",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657090601",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657090610",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760099190",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382079805",
      "ndc_label_name": "Labetalol HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930003512",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043911",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888012001",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629221101",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760023190",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629889901",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135079160",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377006012",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760061090",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335073301",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001038103",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162167505",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760078490",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888012005",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205009590",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629221201",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930003552",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377006013",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335073302",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162167501",
      "ndc_label_name": "Labetalol HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767960",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904745261",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781055305",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591060605",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135071205",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064201",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185011701",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185011705",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591060601",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090677400",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090677700",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904711061",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090129000",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781055301",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090677800",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135071201",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155072401",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090700100",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657090701",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155072405",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090700101",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884012305",
      "ndc_label_name": "Labetalol HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090700200",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090129001",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884012301",
      "ndc_label_name": "Labetalol HCl TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382079901",
      "ndc_label_name": "Labetalol HCl TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629221301",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090677401",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090752300",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382079905",
      "ndc_label_name": "Labetalol HCl TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090752301",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407061505",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090677701",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71247012701",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335287601",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773100",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407061501",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162167605",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657060301",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657090710",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090752400",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888012105",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162167601",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687045001",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657060350",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135079260",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629221401",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687045011",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629890001",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629116401",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888012101",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377006113",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629116301",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001038200",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629930001",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71247012705",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629890101",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001038203",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377006112",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335292301",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930003612",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930003652",
      "ndc_label_name": "Labetalol HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064301",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904711161",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135071301",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185011801",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591060701",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135071305",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185011805",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687046101",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657060450",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904745361",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884012401",
      "ndc_label_name": "Labetalol HCl TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155072501",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687046111",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657090801",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155072505",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629221501",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629918502",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090129101",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090766601",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781055401",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135080060",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629890301",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657060401",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001038303",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001038300",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090715601",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629918501",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884012405",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162167701",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162167705",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629221601",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377006212",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377006213",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407061601",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629928301",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090683301",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382080001",
      "ndc_label_name": "Labetalol HCl TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888012201",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069605",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71247013001",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888046802",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629116501",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090774301",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629116601",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657090810",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382080005",
      "ndc_label_name": "Labetalol HCl TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629890201",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71247013005",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888012205",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930003712",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888046801",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930003752",
      "ndc_label_name": "Labetalol HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121202495",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121198495",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121404895",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315031820",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121303695",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121198410",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121099205",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121099295",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687084755",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689011001",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722062726",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921041171",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689010810",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687084740",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121202410",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121101205",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877073295",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689011010",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687084754",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205003474",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954048810",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135088522",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505040504",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121101295",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687084782",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689010710",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687084742",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121303615",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689010910",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82983042731",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315031846",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121404874",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603030501",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651001602",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687084724",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462094086",
      "ndc_label_name": "Lacosamide Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714054901",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335092286",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099172",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904724568",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135080060",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099130",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991034905",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300036516",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991034906",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407072260",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462067960",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291086160",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808024401",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099100",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367034960",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342030309",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722081360",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099155",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099164",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068757",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068711",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099178",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099190",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228019360",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162092406",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332017260",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862074860",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877073460",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921022106",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099111",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099160",
      "ndc_label_name": "Lacosamide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228019460",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991035005",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135080160",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904724668",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808024501",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367035060",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714055001",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862074960",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099290",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162092506",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722081460",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291086260",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300036616",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099230",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342030409",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335094386",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099200",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877073560",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099278",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407072360",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099255",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099260",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099264",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991035006",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462068060",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332017360",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921022206",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099272",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099211",
      "ndc_label_name": "Lacosamide Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991035105",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407072460",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335098086",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300036716",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714055201",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135080260",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904724768",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342030509",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462068160",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687069857",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687069811",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291086360",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332017460",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877073660",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808024601",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991035106",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099360",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162092606",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722081560",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228019560",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099300",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921022306",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862075060",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099364",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099311",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367035160",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099355",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099372",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099330",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099390",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099378",
      "ndc_label_name": "Lacosamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135079960",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722081260",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991034806",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714054801",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904724468",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332017160",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808024301",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425051002",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300036416",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228019260",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425051003",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099030",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335091886",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877073360",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342030209",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099064",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067657",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425051001",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099078",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099072",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407072160",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921022006",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291086060",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099055",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462067860",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162092306",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991034805",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099011",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067611",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099060",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862074760",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367034860",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099000",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099090",
      "ndc_label_name": "Lacosamide Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00990795302",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264775007",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264775020",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338011703",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338960012",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264775000",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264775010",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990795303",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047705",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047905",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338011702",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990795309",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016424",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338011704",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338960001",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016475",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047505",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271071007",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016425",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271071005",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016426",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047530",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016474",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323016476",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271071006",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047720",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047910",
      "ndc_label_name": "Lactated Ringers Solution Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83745024908",
      "ndc_label_name": "Lactulose Encephalopathy Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668057410",
      "ndc_label_name": "Lactulose Encephalopathy Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980059295",
      "ndc_label_name": "Lactulose Encephalopathy Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668057408",
      "ndc_label_name": "Lactulose Encephalopathy Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668057412",
      "ndc_label_name": "Lactulose Encephalopathy Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980059248",
      "ndc_label_name": "Lactulose Encephalopathy Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83745024916",
      "ndc_label_name": "Lactulose Encephalopathy Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033024132",
      "ndc_label_name": "Lactulose Encephalopathy Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83745024932",
      "ndc_label_name": "Lactulose Encephalopathy Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383079516",
      "ndc_label_name": "Lactulose Encephalopathy Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121115406",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121115430",
      "ndc_label_name": "Lactulose SOLUTION 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121115400",
      "ndc_label_name": "Lactulose SOLUTION 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00116400516",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00116400508",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00116400532",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00116400515",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121057708",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527512570",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527512070",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527512578",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121087308",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00116400540",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121087316",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668058010",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527512078",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856137801",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383035733",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383035617",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121087332",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121115440",
      "ndc_label_name": "Lactulose SOLUTION 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959076402",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383035731",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668058008",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383077915",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135000224",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383077916",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121457740",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121457706",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135000347",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154944805",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383035730",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383077932",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135000294",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432003732",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689003950",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121457715",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83745040532",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135000237",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383077917",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700089232",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83745040516",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135000251",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999000224",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668058012",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672424309",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804010747",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135000247",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432003708",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135000337",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090338100",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135000394",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071156206",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689003901",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383035615",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033024150",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999000251",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83745040508",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033024115",
      "ndc_label_name": "Lactulose Solution 10 GM/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54838056670",
      "ndc_label_name": "lamiVUDine Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237027424",
      "ndc_label_name": "LamiVUDine SOLUTION 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005524",
      "ndc_label_name": "LamiVUDine SOLUTION 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135060571",
      "ndc_label_name": "LamiVUDine SOLUTION 10 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135070637",
      "ndc_label_name": "lamiVUDine Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407086660",
      "ndc_label_name": "lamiVUDine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505325006",
      "ndc_label_name": "LamiVUDine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722075260",
      "ndc_label_name": "LamiVUDine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993047860",
      "ndc_label_name": "lamiVUDine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429035360",
      "ndc_label_name": "LamiVUDine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722075360",
      "ndc_label_name": "LamiVUDine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072021",
      "ndc_label_name": "lamiVUDine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687036221",
      "ndc_label_name": "lamiVUDine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742062360",
      "ndc_label_name": "LamiVUDine TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904658304",
      "ndc_label_name": "LamiVUDine TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342000109",
      "ndc_label_name": "LamiVUDine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862002560",
      "ndc_label_name": "LamiVUDine TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180060207",
      "ndc_label_name": "lamiVUDine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380071003",
      "ndc_label_name": "LamiVUDine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505325106",
      "ndc_label_name": "LamiVUDine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072011",
      "ndc_label_name": "lamiVUDine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687036211",
      "ndc_label_name": "lamiVUDine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293083268",
      "ndc_label_name": "lamiVUDine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380071104",
      "ndc_label_name": "LamiVUDine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429035430",
      "ndc_label_name": "LamiVUDine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722075430",
      "ndc_label_name": "LamiVUDine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180060306",
      "ndc_label_name": "LamiVUDine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342000207",
      "ndc_label_name": "LamiVUDine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505325203",
      "ndc_label_name": "LamiVUDine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862002630",
      "ndc_label_name": "LamiVUDine TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003660",
      "ndc_label_name": "lamiVUDine-Zidovudine Tablet 150-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006102",
      "ndc_label_name": "Lamivudine-Zidovudine TABLET 150-300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722050660",
      "ndc_label_name": "Lamivudine-Zidovudine TABLET 150-300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090006",
      "ndc_label_name": "Lamivudine-Zidovudine Tablet 150-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090141900",
      "ndc_label_name": "Lamivudine-Zidovudine Tablet 150-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342000309",
      "ndc_label_name": "Lamivudine-Zidovudine Tablet 150-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380070703",
      "ndc_label_name": "lamiVUDine-Zidovudine Tablet 150-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268045611",
      "ndc_label_name": "lamiVUDine-Zidovudine Tablet 150-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865014460",
      "ndc_label_name": "lamiVUDine-Zidovudine Tablet 150-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268045612",
      "ndc_label_name": "lamiVUDine-Zidovudine Tablet 150-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76519100506",
      "ndc_label_name": "Lamivudine-Zidovudine TABLET 150-300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071090806",
      "ndc_label_name": "Lamivudine-Zidovudine TABLET 150-300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180028407",
      "ndc_label_name": "lamiVUDine-Zidovudine Tablet 150-300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769630",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668004705",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769610",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904700861",
      "ndc_label_name": "LamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769620",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090582700",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291036710",
      "ndc_label_name": "LamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714070101",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356044800",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714019501",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436014901",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011201",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668004701",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090582702",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063020390",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063020360",
      "ndc_label_name": "LamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090281400",
      "ndc_label_name": "LamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011205",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746024601",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011210",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063020330",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090582800",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187074430",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090582701",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053430",
      "ndc_label_name": "LamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291036701",
      "ndc_label_name": "LamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788722306",
      "ndc_label_name": "LamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090213002",
      "ndc_label_name": "LamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090213001",
      "ndc_label_name": "LamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111022105",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862022801",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746024610",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084031901",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090213000",
      "ndc_label_name": "LamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097014915",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332003831",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787103",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429077501",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084031911",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009013210",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788722303",
      "ndc_label_name": "LamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672413101",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382000801",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382000810",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205024590",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919080230",
      "ndc_label_name": "LamoTRIgine TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097014912",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787106",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700062660",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097014907",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788722309",
      "ndc_label_name": "LamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205024530",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020660",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888002600",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788787109",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888002605",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888002601",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335232801",
      "ndc_label_name": "lamoTRIgine Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769730",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011305",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714019601",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769720",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769710",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090246600",
      "ndc_label_name": "LamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668004805",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291036850",
      "ndc_label_name": "LamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714070201",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764703",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011316",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746024705",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668004801",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746024760",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668004860",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672413204",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090213101",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764706",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291036860",
      "ndc_label_name": "LamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687069301",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090585001",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629469704",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090213100",
      "ndc_label_name": "LamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111022260",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382000914",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764709",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090585000",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687069311",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888002705",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862022901",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111022205",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629469701",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009013305",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015112",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332003960",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888002760",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629469702",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629469703",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862022960",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382000905",
      "ndc_label_name": "LamoTRIgine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015103",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015115",
      "ndc_label_name": "lamoTRIgine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769810",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291036950",
      "ndc_label_name": "LamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011416",
      "ndc_label_name": "LamoTRIgine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668004905",
      "ndc_label_name": "LamoTRIgine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769820",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687070411",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714019701",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668004960",
      "ndc_label_name": "LamoTRIgine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769830",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291036960",
      "ndc_label_name": "LamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090602800",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011405",
      "ndc_label_name": "LamoTRIgine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015203",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382001014",
      "ndc_label_name": "LamoTRIgine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714070301",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090391400",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090327800",
      "ndc_label_name": "LamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382001005",
      "ndc_label_name": "LamoTRIgine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746024860",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090312900",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015215",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888002805",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015212",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111022305",
      "ndc_label_name": "LamoTRIgine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672413304",
      "ndc_label_name": "LamoTRIgine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009013405",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862023001",
      "ndc_label_name": "LamoTRIgine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746024805",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919077730",
      "ndc_label_name": "LamoTRIgine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804006830",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862023060",
      "ndc_label_name": "LamoTRIgine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111022360",
      "ndc_label_name": "LamoTRIgine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629417102",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687070401",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716809",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004060",
      "ndc_label_name": "LamoTRIgine TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335191903",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862023099",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716806",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716803",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888002860",
      "ndc_label_name": "lamoTRIgine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769510",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011101",
      "ndc_label_name": "LamoTRIgine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769520",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011105",
      "ndc_label_name": "LamoTRIgine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714019401",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668004501",
      "ndc_label_name": "LamoTRIgine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291036610",
      "ndc_label_name": "LamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668004505",
      "ndc_label_name": "LamoTRIgine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769530",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063023830",
      "ndc_label_name": "LamoTRIgine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714070001",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317100",
      "ndc_label_name": "LamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317101",
      "ndc_label_name": "LamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672413001",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090212901",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011110",
      "ndc_label_name": "LamoTRIgine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904700761",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090282500",
      "ndc_label_name": "LamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788754406",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746024505",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862022701",
      "ndc_label_name": "LamoTRIgine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111022005",
      "ndc_label_name": "LamoTRIgine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700068330",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111022001",
      "ndc_label_name": "LamoTRIgine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291036601",
      "ndc_label_name": "LamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090310300",
      "ndc_label_name": "LamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839203",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097014812",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090212900",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084031801",
      "ndc_label_name": "LamoTRIgine TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760047430",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746024501",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090212902",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700068360",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839206",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888002501",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082290",
      "ndc_label_name": "LamoTRIgine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189006330",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187048760",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760054330",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332003731",
      "ndc_label_name": "LamoTRIgine TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760005030",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097014807",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028902",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382000610",
      "ndc_label_name": "LamoTRIgine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760054930",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788754403",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629418301",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788754409",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187048790",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839209",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084031811",
      "ndc_label_name": "LamoTRIgine TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097014815",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888002505",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888002500",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382000601",
      "ndc_label_name": "LamoTRIgine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028903",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028901",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009013110",
      "ndc_label_name": "lamoTRIgine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078601",
      "ndc_label_name": "LamoTRIgine Tablet Chewable 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111022601",
      "ndc_label_name": "LamoTRIgine TABLET CHEWABLE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440768910",
      "ndc_label_name": "LamoTRIgine Tablet Chewable 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672414001",
      "ndc_label_name": "LamoTRIgine Tablet Chewable 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51129464602",
      "ndc_label_name": "LamoTRIgine Tablet Chewable 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111022605",
      "ndc_label_name": "LamoTRIgine TABLET CHEWABLE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440768920",
      "ndc_label_name": "LamoTRIgine Tablet Chewable 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009631",
      "ndc_label_name": "LamoTRIgine TABLET CHEWABLE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440768930",
      "ndc_label_name": "LamoTRIgine Tablet Chewable 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862036201",
      "ndc_label_name": "LamoTRIgine TABLET CHEWABLE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462022901",
      "ndc_label_name": "LamoTRIgine TABLET CHEWABLE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767310",
      "ndc_label_name": "LamoTRIgine Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767330",
      "ndc_label_name": "LamoTRIgine Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769120",
      "ndc_label_name": "LamoTRIgine Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767320",
      "ndc_label_name": "LamoTRIgine Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672413901",
      "ndc_label_name": "LamoTRIgine Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462022801",
      "ndc_label_name": "LamoTRIgine TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332009531",
      "ndc_label_name": "LamoTRIgine TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078501",
      "ndc_label_name": "LamoTRIgine Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862036101",
      "ndc_label_name": "LamoTRIgine TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769130",
      "ndc_label_name": "LamoTRIgine Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769110",
      "ndc_label_name": "LamoTRIgine Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111022501",
      "ndc_label_name": "LamoTRIgine TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "56151024221",
      "ndc_label_name": "Lancets 28G Thin",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917012580",
      "ndc_label_name": "Lancets Ultra Thin 30G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015018",
      "ndc_label_name": "Lancets Ultra Thin 30G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00093735056",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781214731",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571069703",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291036401",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536136813",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536132413",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "31722057030",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378801593",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536136888",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800011703",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "35356062030",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919089030",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722057090",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802024502",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598010927",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00781214710",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11917014066",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "42291036430",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "36800011702",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "67877027430",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802024501",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802087801",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598010952",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16571074242",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802087803",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090607900",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291043301",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382054310",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639002",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090140700",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111039890",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802087802",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60687011111",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919024560",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802024503",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788639003",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778903",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001011104",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001011105",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687011121",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639008",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629563201",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111039830",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639006",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70000006903",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788639001",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004301",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919024530",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70000061201",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68382054306",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175041532",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639009",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335005801",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778901",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004302",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70000006902",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70756080630",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70000061202",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788639004",
      "ndc_label_name": "Lansoprazole CAPSULE DELAYED RELEASE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778909",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189027960",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778906",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014802",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004303",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778908",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004304",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335005803",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004305",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70000006901",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335295701",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189027990",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014801",
      "ndc_label_name": "Lansoprazole Capsule Delayed Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180080136",
      "ndc_label_name": "Lapatinib Ditosylate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480323751",
      "ndc_label_name": "Lapatinib Ditosylate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291003515",
      "ndc_label_name": "Lapatinib Ditosylate Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "25021000102",
      "ndc_label_name": "Latanoprost Solution 0.005 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090124000",
      "ndc_label_name": "Latanoprost Solution 0.005 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090192000",
      "ndc_label_name": "Latanoprost Solution 0.005 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478062512",
      "ndc_label_name": "Latanoprost Solution 0.005 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762033302",
      "ndc_label_name": "Latanoprost SOLUTION 0.005 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069042101",
      "ndc_label_name": "Latanoprost Solution 0.005 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090706200",
      "ndc_label_name": "Latanoprost Solution 0.005 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069042103",
      "ndc_label_name": "Latanoprost Solution 0.005 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61314054701",
      "ndc_label_name": "Latanoprost SOLUTION 0.005 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24208046325",
      "ndc_label_name": "Latanoprost SOLUTION 0.005 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61314054703",
      "ndc_label_name": "Latanoprost SOLUTION 0.005 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980051625",
      "ndc_label_name": "Latanoprost Solution 0.005 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71384051507",
      "ndc_label_name": "Latanoprost Solution 0.005 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462094403",
      "ndc_label_name": "Latanoprost Solution 0.005 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862087225",
      "ndc_label_name": "Latanoprost Solution 0.005 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205015425",
      "ndc_label_name": "Latanoprost Solution 0.005 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70000007701",
      "ndc_label_name": "Laxative Max Str Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72626260101",
      "ndc_label_name": "Ledipasvir-Sofosbuvir Tablet 90-400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710115703",
      "ndc_label_name": "Leflunomide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332006130",
      "ndc_label_name": "Leflunomide TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162240903",
      "ndc_label_name": "Leflunomide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155004303",
      "ndc_label_name": "Leflunomide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291042030",
      "ndc_label_name": "Leflunomide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268047711",
      "ndc_label_name": "Leflunomide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268047715",
      "ndc_label_name": "Leflunomide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702027703",
      "ndc_label_name": "Leflunomide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505250201",
      "ndc_label_name": "Leflunomide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70748012906",
      "ndc_label_name": "Leflunomide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135079330",
      "ndc_label_name": "Leflunomide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573044730",
      "ndc_label_name": "Leflunomide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335287401",
      "ndc_label_name": "Leflunomide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651034830",
      "ndc_label_name": "Leflunomide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505250203",
      "ndc_label_name": "Leflunomide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00955173730",
      "ndc_label_name": "Leflunomide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291042130",
      "ndc_label_name": "Leflunomide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702027803",
      "ndc_label_name": "Leflunomide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090753700",
      "ndc_label_name": "Leflunomide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70748013006",
      "ndc_label_name": "Leflunomide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573044830",
      "ndc_label_name": "Leflunomide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155004403",
      "ndc_label_name": "Leflunomide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090599200",
      "ndc_label_name": "Leflunomide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651034930",
      "ndc_label_name": "Leflunomide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268047815",
      "ndc_label_name": "Leflunomide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505250303",
      "ndc_label_name": "Leflunomide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268047811",
      "ndc_label_name": "Leflunomide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335283201",
      "ndc_label_name": "Leflunomide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332006230",
      "ndc_label_name": "Leflunomide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505250301",
      "ndc_label_name": "Leflunomide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710115803",
      "ndc_label_name": "Leflunomide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135079430",
      "ndc_label_name": "Leflunomide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162241003",
      "ndc_label_name": "Leflunomide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480124328",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378193701",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378193728",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574141028",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781048501",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651034428",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097038273",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729069409",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781048528",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722025928",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710103207",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505453402",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377005113",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219171601",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282069848",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598051263",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82293000810",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73043004001",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304004327",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73043004028",
      "ndc_label_name": "Lenalidomide Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722026021",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598051321",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097038381",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378194101",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574141521",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505453502",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781048601",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378194121",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73043004121",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651034521",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781048677",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480124421",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710103308",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304004422",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219171701",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73043004101",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729069506",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82293000910",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377005211",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282069947",
      "ndc_label_name": "Lenalidomide Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505453702",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651034721",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574142521",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781048877",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729069706",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378194021",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378194001",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710103508",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304004622",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722026221",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282070147",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73043004321",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781048801",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097038581",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480124621",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82293001110",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73043004301",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598051521",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219171901",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377005411",
      "ndc_label_name": "Lenalidomide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480124228",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722025828",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729069309",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097038173",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73043003928",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598051163",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378193601",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505453302",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781048428",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781048401",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378193628",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282069748",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73043003901",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219171501",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574140528",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651034328",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377005013",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304004227",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710103107",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82293000710",
      "ndc_label_name": "Lenalidomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856071030",
      "ndc_label_name": "Lenvima (10 MG Daily Dose) Capsule Therapy Pack 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856071005",
      "ndc_label_name": "Lenvima (10 MG Daily Dose) Capsule Therapy Pack 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856071205",
      "ndc_label_name": "Lenvima (12 MG Daily Dose) Capsule Therapy Pack 3 x 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856071230",
      "ndc_label_name": "Lenvima (12 MG Daily Dose) Capsule Therapy Pack 3 x 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856071430",
      "ndc_label_name": "Lenvima (14 MG Daily Dose) Capsule Therapy Pack 10 & 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856071405",
      "ndc_label_name": "Lenvima (14 MG Daily Dose) Capsule Therapy Pack 10 & 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856071805",
      "ndc_label_name": "Lenvima (18 MG Daily Dose) Capsule Therapy Pack 10 MG & 2 x 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856071830",
      "ndc_label_name": "Lenvima (18 MG Daily Dose) Capsule Therapy Pack 10 MG & 2 x 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856072030",
      "ndc_label_name": "Lenvima (20 MG Daily Dose) Capsule Therapy Pack 2 x 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856072005",
      "ndc_label_name": "Lenvima (20 MG Daily Dose) Capsule Therapy Pack 2 x 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856072405",
      "ndc_label_name": "Lenvima (24 MG Daily Dose) Capsule Therapy Pack 2 x 10 MG & 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856072430",
      "ndc_label_name": "Lenvima (24 MG Daily Dose) Capsule Therapy Pack 2 x 10 MG & 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856070430",
      "ndc_label_name": "Lenvima (4 MG Daily Dose) Capsule Therapy Pack 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856070405",
      "ndc_label_name": "Lenvima (4 MG Daily Dose) Capsule Therapy Pack 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856070805",
      "ndc_label_name": "Lenvima (8 MG Daily Dose) Capsule Therapy Pack 2 x 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62856070830",
      "ndc_label_name": "Lenvima (8 MG Daily Dose) Capsule Therapy Pack 2 x 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729003410",
      "ndc_label_name": "Letrozole TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090347400",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291037490",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155087503",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69117000401",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729003415",
      "ndc_label_name": "Letrozole TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093762056",
      "ndc_label_name": "Letrozole TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979072606",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651018090",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991075933",
      "ndc_label_name": "Letrozole TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991075910",
      "ndc_label_name": "Letrozole TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155087509",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155087510",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268047615",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979072607",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291037430",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407098690",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651018030",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135049130",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268047611",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135049190",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991075990",
      "ndc_label_name": "Letrozole Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806013321",
      "ndc_label_name": "Leucovorin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742018212",
      "ndc_label_name": "Leucovorin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054449710",
      "ndc_label_name": "Leucovorin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806013324",
      "ndc_label_name": "Leucovorin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742018224",
      "ndc_label_name": "Leucovorin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315018524",
      "ndc_label_name": "Leucovorin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054449705",
      "ndc_label_name": "Leucovorin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315018512",
      "ndc_label_name": "Leucovorin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742018324",
      "ndc_label_name": "Leucovorin Calcium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054449810",
      "ndc_label_name": "Leucovorin Calcium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806013424",
      "ndc_label_name": "Leucovorin Calcium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315018624",
      "ndc_label_name": "Leucovorin Calcium Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687022711",
      "ndc_label_name": "Leucovorin Calcium TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054449911",
      "ndc_label_name": "Leucovorin Calcium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904670310",
      "ndc_label_name": "Leucovorin Calcium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079058205",
      "ndc_label_name": "Leucovorin Calcium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742018425",
      "ndc_label_name": "Leucovorin Calcium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687022794",
      "ndc_label_name": "Leucovorin Calcium TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555048527",
      "ndc_label_name": "Leucovorin Calcium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315018725",
      "ndc_label_name": "Leucovorin Calcium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806035925",
      "ndc_label_name": "Leucovorin Calcium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079058201",
      "ndc_label_name": "Leucovorin Calcium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054449613",
      "ndc_label_name": "Leucovorin Calcium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742018130",
      "ndc_label_name": "Leucovorin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555048401",
      "ndc_label_name": "Leucovorin Calcium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054849619",
      "ndc_label_name": "Leucovorin Calcium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315018403",
      "ndc_label_name": "Leucovorin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079058101",
      "ndc_label_name": "Leucovorin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054449625",
      "ndc_label_name": "Leucovorin Calcium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806035801",
      "ndc_label_name": "Leucovorin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50742018101",
      "ndc_label_name": "Leucovorin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079058106",
      "ndc_label_name": "Leucovorin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205090800",
      "ndc_label_name": "Leucovorin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555048402",
      "ndc_label_name": "Leucovorin Calcium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205090830",
      "ndc_label_name": "Leucovorin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806035830",
      "ndc_label_name": "Leucovorin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205090890",
      "ndc_label_name": "Leucovorin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205090860",
      "ndc_label_name": "Leucovorin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315018401",
      "ndc_label_name": "Leucovorin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205090811",
      "ndc_label_name": "Leucovorin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205090855",
      "ndc_label_name": "Leucovorin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69784061025",
      "ndc_label_name": "Leukeran Tablet 2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76388063525",
      "ndc_label_name": "Leukeran Tablet 2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80725061025",
      "ndc_label_name": "Leukeran Tablet 2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121210602",
      "ndc_label_name": "Leuprolide Acetate Kit 1 MG/0.2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72664061128",
      "ndc_label_name": "Leuprolide Acetate Kit 1 MG/0.2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781400332",
      "ndc_label_name": "Leuprolide Acetate Kit 1 MG/0.2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714057201",
      "ndc_label_name": "Leuprolide Acetate Kit 1 MG/0.2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150047801",
      "ndc_label_name": "Leuprolide Acetate Kit 1 MG/0.2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288056990",
      "ndc_label_name": "Leuprolide Acetate Kit 1 MG/0.2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121253706",
      "ndc_label_name": "Leuprolide Acetate Kit 1 MG/0.2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634045461",
      "ndc_label_name": "Leuprolide Acetate Kit 1 MG/0.2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603034401",
      "ndc_label_name": "Leuprolide Acetate Kit 1 MG/0.2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335093640",
      "ndc_label_name": "Leuprolide Acetate Kit 1 MG/0.2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629882101",
      "ndc_label_name": "Leuprolide Acetate Kit 1 MG/0.2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205088060",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505328006",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088055",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228018960",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335057386",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001011306",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291038760",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180011707",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69076050060",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088000",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034506",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088030",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088011",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088090",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429034960",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088064",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088072",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189051060",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367033260",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088078",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834024560",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001011406",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088111",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088155",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291038860",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034606",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088164",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228019060",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335057686",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088160",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088172",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505351706",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088190",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429035060",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088178",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088130",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180011807",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81665010060",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69076075060",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367033360",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088100",
      "ndc_label_name": "LevETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834024660",
      "ndc_label_name": "levETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121159810",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121479940",
      "ndc_label_name": "LevETIRAcetam SOLUTION 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121079916",
      "ndc_label_name": "LevETIRAcetam SOLUTION 100 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904706093",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904726594",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856614103",
      "ndc_label_name": "LevETIRAcetam SOLUTION 100 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904742016",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121480205",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121159820",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904706092",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121479950",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904706094",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328051150",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739001970",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432083116",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472023516",
      "ndc_label_name": "LevETIRAcetam SOLUTION 100 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904726592",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904726593",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328051140",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714035801",
      "ndc_label_name": "LevETIRAcetam SOLUTION 100 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268047013",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033001350",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687024967",
      "ndc_label_name": "LevETIRAcetam SOLUTION 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39328051130",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268047011",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135069508",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383024116",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672413609",
      "ndc_label_name": "LevETIRAcetam SOLUTION 100 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383024106",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856024105",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687024977",
      "ndc_label_name": "LevETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383024105",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991065116",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856057401",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629207301",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629961501",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54838054880",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722057447",
      "ndc_label_name": "LevETIRAcetam SOLUTION 100 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135054847",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689002801",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687024986",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180009901",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205003772",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739001971",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135054824",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70166008102",
      "ndc_label_name": "LevETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339015705",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689002850",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135054845",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752020312",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339015717",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033001305",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862025047",
      "ndc_label_name": "LevETIRAcetam SOLUTION 100 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689010220",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093014413",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452041288",
      "ndc_label_name": "levETIRAcetam Solution 100 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739015878",
      "ndc_label_name": "levETIRAcetam Solution 500 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739015832",
      "ndc_label_name": "levETIRAcetam Solution 500 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001705",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090637801",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808026601",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722053960",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378561991",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714031001",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001760",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729006712",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001712",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180011507",
      "ndc_label_name": "LevETIRAcetam TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090351800",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608602",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571079006",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385095760",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090287500",
      "ndc_label_name": "LevETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326400",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714035701",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608600",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090637800",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733302",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084089311",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090637802",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090287501",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009012460",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547022406",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006860",
      "ndc_label_name": "LevETIRAcetam TABLET 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343007260",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687066801",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090287502",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980060706",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608601",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877077160",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733301",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180011502",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862031560",
      "ndc_label_name": "LevETIRAcetam TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205009760",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090777002",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228047360",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090777101",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084089301",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090780401",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012602",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687066811",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930006560",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083060",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865019060",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001040506",
      "ndc_label_name": "levETIRAcetam Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378561305",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001425",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904712361",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078750",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378561378",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714003401",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001405",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714003402",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714035401",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078712",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808026301",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722053612",
      "ndc_label_name": "LevETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228047005",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714035402",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001412",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729006429",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032060",
      "ndc_label_name": "LevETIRAcetam TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980060412",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722053605",
      "ndc_label_name": "LevETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919055260",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180011209",
      "ndc_label_name": "LevETIRAcetam TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729006416",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343006905",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228047012",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629467501",
      "ndc_label_name": "LevETIRAcetam TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980060450",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385095412",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629467503",
      "ndc_label_name": "LevETIRAcetam TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018705",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808026302",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085901",
      "ndc_label_name": "LevETIRAcetam TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343006912",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862024505",
      "ndc_label_name": "LevETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001040207",
      "ndc_label_name": "LevETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032072",
      "ndc_label_name": "LevETIRAcetam TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788403",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862024508",
      "ndc_label_name": "LevETIRAcetam TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547022115",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180011216",
      "ndc_label_name": "LevETIRAcetam TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919055272",
      "ndc_label_name": "LevETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788406",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085911",
      "ndc_label_name": "LevETIRAcetam TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739079510",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189019060",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788409",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629467502",
      "ndc_label_name": "LevETIRAcetam TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877076805",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205009492",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012312",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189019090",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877076812",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009012105",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189019030",
      "ndc_label_name": "LevETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001040203",
      "ndc_label_name": "LevETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180011202",
      "ndc_label_name": "LevETIRAcetam TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018712",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788401",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788402",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930006215",
      "ndc_label_name": "levETIRAcetam Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808026402",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722053712",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714003502",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378561505",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378561578",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714035501",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904712461",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001512",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090752100",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049960",
      "ndc_label_name": "LevETIRAcetam TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722053705",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729006516",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078812",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547022215",
      "ndc_label_name": "LevETIRAcetam TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001505",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001525",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090752102",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771703",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385095512",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808026401",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078850",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090133303",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714035502",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063061760",
      "ndc_label_name": "LevETIRAcetam TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154569900",
      "ndc_label_name": "LevETIRAcetam TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228047112",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111018204",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090752101",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714003501",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090133304",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729006529",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090133301",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687065701",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079082120",
      "ndc_label_name": "LevETIRAcetam TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919068590",
      "ndc_label_name": "LevETIRAcetam TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090776800",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547022250",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090281500",
      "ndc_label_name": "LevETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385095505",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090133302",
      "ndc_label_name": "LevETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687065711",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343007012",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187036030",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090782001",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090133300",
      "ndc_label_name": "LevETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736801",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736800",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090213400",
      "ndc_label_name": "LevETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629413701",
      "ndc_label_name": "LevETIRAcetam TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919068572",
      "ndc_label_name": "LevETIRAcetam TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001040303",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079082101",
      "ndc_label_name": "LevETIRAcetam TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771700",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736803",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736802",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771702",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980060550",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180011316",
      "ndc_label_name": "LevETIRAcetam TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084087011",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919068560",
      "ndc_label_name": "LevETIRAcetam TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771701",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090782000",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090752103",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343007005",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862024608",
      "ndc_label_name": "LevETIRAcetam TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707402",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707406",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707401",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228047105",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980060512",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090776801",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919055990",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877076905",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707409",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056501",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857709",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877076912",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862024605",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919055960",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919068530",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707403",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012412",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056504",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884306",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001040307",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825402",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739041110",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084087001",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884303",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335074804",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056604",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884309",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825401",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884302",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180011302",
      "ndc_label_name": "LevETIRAcetam TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825409",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012405",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335975701",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180011309",
      "ndc_label_name": "LevETIRAcetam TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930006352",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825406",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335074802",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825403",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335074803",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205009592",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022990",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884301",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930006315",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018805",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789015260",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335074801",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022960",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056602",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056503",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335228201",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056502",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018812",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056601",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056603",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009012205",
      "ndc_label_name": "levETIRAcetam Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078912",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378561778",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904712561",
      "ndc_label_name": "LevETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714053702",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378561705",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571078950",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001612",
      "ndc_label_name": "LevETIRAcetam TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001605",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714035601",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729006629",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714053701",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228047212",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001625",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385095612",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084088201",
      "ndc_label_name": "LevETIRAcetam TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714035602",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877077005",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343007112",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722053812",
      "ndc_label_name": "LevETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180011402",
      "ndc_label_name": "LevETIRAcetam TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729006616",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739078710",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084088211",
      "ndc_label_name": "LevETIRAcetam TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722053805",
      "ndc_label_name": "LevETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001040407",
      "ndc_label_name": "LevETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980060650",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547022315",
      "ndc_label_name": "LevETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343007105",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808026501",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980060612",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180011409",
      "ndc_label_name": "LevETIRAcetam TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877077012",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808026502",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228047205",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111018304",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930006415",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001040403",
      "ndc_label_name": "LevETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862024705",
      "ndc_label_name": "LevETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180011416",
      "ndc_label_name": "LevETIRAcetam TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205009692",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018912",
      "ndc_label_name": "LevETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862024708",
      "ndc_label_name": "LevETIRAcetam TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009012305",
      "ndc_label_name": "levETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012512",
      "ndc_label_name": "LevETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865018905",
      "ndc_label_name": "LevETIRAcetam Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24208050505",
      "ndc_label_name": "Levobunolol HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954013910",
      "ndc_label_name": "LevOCARNitine Solution 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383017104",
      "ndc_label_name": "levOCARNitine Solution 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71656001651",
      "ndc_label_name": "levOCARNitine Solution 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980050312",
      "ndc_label_name": "LevOCARNitine SOLUTION 1 GM/10ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817083004",
      "ndc_label_name": "levOCARNitine Solution 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71656001650",
      "ndc_label_name": "levOCARNitine Solution 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571076209",
      "ndc_label_name": "levOCARNitine Tablet 330 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383017290",
      "ndc_label_name": "levOCARNitine Tablet 330 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954049210",
      "ndc_label_name": "levOCARNitine Tablet 330 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571015050",
      "ndc_label_name": "levoFLOXacin Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888014222",
      "ndc_label_name": "levoFLOXacin Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478010610",
      "ndc_label_name": "levoFLOXacin Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527194866",
      "ndc_label_name": "levoFLOXacin Solution 25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383028604",
      "ndc_label_name": "levoFLOXacin Solution 25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527194870",
      "ndc_label_name": "levoFLOXacin Solution 25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527194868",
      "ndc_label_name": "levoFLOXacin Solution 25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383028616",
      "ndc_label_name": "levoFLOXacin Solution 25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954085220",
      "ndc_label_name": "levoFLOXacin Solution 25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121087220",
      "ndc_label_name": "levoFLOXacin Solution 25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954085210",
      "ndc_label_name": "levoFLOXacin Solution 25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954085230",
      "ndc_label_name": "levoFLOXacin Solution 25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383028608",
      "ndc_label_name": "levoFLOXacin Solution 25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904635161",
      "ndc_label_name": "Levofloxacin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111027950",
      "ndc_label_name": "Levofloxacin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629484304",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135065514",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440771414",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440771407",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440771403",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342002108",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324501",
      "ndc_label_name": "Levofloxacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629484303",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090249801",
      "ndc_label_name": "Levofloxacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180024001",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781579001",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440771410",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324502",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342053108",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090479701",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781579050",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919098710",
      "ndc_label_name": "Levofloxacin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205005821",
      "ndc_label_name": "Levofloxacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722072150",
      "ndc_label_name": "Levofloxacin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035910",
      "ndc_label_name": "Levofloxacin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092521",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321900",
      "ndc_label_name": "Levofloxacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407042850",
      "ndc_label_name": "Levofloxacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862053650",
      "ndc_label_name": "Levofloxacin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578009818",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629484301",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343011950",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629484302",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180024008",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335079402",
      "ndc_label_name": "levoFLOXacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440771510",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440771502",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440771503",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904635261",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063810",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781579101",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781579150",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440771585",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440771581",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440771507",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045707",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063805",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700072914",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063807",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045720",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722072250",
      "ndc_label_name": "LevoFLOXacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045705",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440771514",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045710",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063814",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919099214",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700072910",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063803",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342053208",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254000",
      "ndc_label_name": "LevoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342002208",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090273600",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063820",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187043814",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919099207",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436658502",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045714",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090457200",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045703",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090296700",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090331101",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005010",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187043810",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877201",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254001",
      "ndc_label_name": "LevoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436002201",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090296300",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090331100",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090331400",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934039210",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071085102",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335043406",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254004",
      "ndc_label_name": "LevoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436658501",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090296301",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919042607",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000307",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000205",
      "ndc_label_name": "LevoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000212",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335227602",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090331104",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343012050",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090331401",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070414",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187043805",
      "ndc_label_name": "LevoFLOXacin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008550",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036707",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000702",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090457201",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070403",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090457300",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919099210",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862053750",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000902",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000701",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000802",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090457204",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000310",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111028050",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135065650",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005007",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180024102",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000704",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187043807",
      "ndc_label_name": "LevoFLOXacin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407042950",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877202",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919042610",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071083810",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934039207",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877204",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919099230",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180024101",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070407",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877207",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187043803",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693801",
      "ndc_label_name": "LevoFLOXacin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578009918",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000203",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180024108",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934005014",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070410",
      "ndc_label_name": "Levofloxacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000214",
      "ndc_label_name": "LevoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693802",
      "ndc_label_name": "LevoFLOXacin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000801",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693807",
      "ndc_label_name": "LevoFLOXacin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693804",
      "ndc_label_name": "LevoFLOXacin TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000207",
      "ndc_label_name": "LevoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000903",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005310",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877203",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000210",
      "ndc_label_name": "LevoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000703",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000901",
      "ndc_label_name": "levoFLOXacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074110",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781579220",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045910",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722072320",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440771607",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781579250",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440771605",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342002332",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135065714",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045907",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045920",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090122801",
      "ndc_label_name": "LevoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342053332",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904635361",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090301302",
      "ndc_label_name": "LevoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079607",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187038410",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090122800",
      "ndc_label_name": "LevoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321402",
      "ndc_label_name": "LevoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090122802",
      "ndc_label_name": "LevoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079605",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045905",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321401",
      "ndc_label_name": "LevoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079610",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187051407",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090301300",
      "ndc_label_name": "LevoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205023405",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090189701",
      "ndc_label_name": "LevoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343012120",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321400",
      "ndc_label_name": "LevoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074105",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090301301",
      "ndc_label_name": "LevoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880902",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436627901",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189033805",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407043020",
      "ndc_label_name": "LevoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187083307",
      "ndc_label_name": "LevoFLOXacin TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111028130",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919086714",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118579204",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880907",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074114",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024807",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076910",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834004",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118579201",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000410",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074107",
      "ndc_label_name": "LevoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205023410",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834001",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187083330",
      "ndc_label_name": "LevoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919086707",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834007",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919044014",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180024220",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187083305",
      "ndc_label_name": "LevoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189033807",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007701",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880901",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919086710",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578010006",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187038405",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880904",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180024201",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009407",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038801",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205023407",
      "ndc_label_name": "LevoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187038407",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024805",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187083310",
      "ndc_label_name": "LevoFLOXacin TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007601",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425038802",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629464206",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862053820",
      "ndc_label_name": "Levofloxacin TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189033814",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834002",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024810",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009410",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189033810",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578010092",
      "ndc_label_name": "levoFLOXacin Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378728153",
      "ndc_label_name": "Levonorgest-Eth Estrad 91-Day Tablet 0.15-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462067295",
      "ndc_label_name": "Levonorgest-Eth Estrad 91-Day TABLET 0.15-0.03 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180084313",
      "ndc_label_name": "Levonorgest-Eth Estrad 91-Day Tablet 0.15-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180084311",
      "ndc_label_name": "Levonorgest-Eth Estrad 91-Day Tablet 0.15-0.03 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462067291",
      "ndc_label_name": "Levonorgest-Eth Estrad 91-Day TABLET 0.15-0.03 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629234301",
      "ndc_label_name": "Levonorgestrel-Ethinyl Estrad Tablet 0.15-30 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378655053",
      "ndc_label_name": "Levonorgestrel-Ethinyl Estrad TABLET 0.15-30 MG-MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328443",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045117",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039711",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480870198",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773090",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328446",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378180910",
      "ndc_label_name": "Levothyroxine Sodium TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480870101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063094930",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090182801",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090764800",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722028810",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480870110",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904695361",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378180977",
      "ndc_label_name": "Levothyroxine Sodium TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045115",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090610101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565400",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049711",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063094990",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722028890",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733601",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090182800",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039710",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090657300",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090657900",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096903",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999079400",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039744",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079044201",
      "ndc_label_name": "Levothyroxine Sodium TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781065110",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079044220",
      "ndc_label_name": "Levothyroxine Sodium TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733700",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788365903",
      "ndc_label_name": "Levothyroxine Sodium TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999079401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781065190",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959008930",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090610100",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090733600",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959008900",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090764900",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880709",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118134509",
      "ndc_label_name": "Levothyroxine Sodium TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090764801",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772903",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655029552",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049701",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919087230",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205001830",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030230",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183407",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934015230",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880703",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096909",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335147800",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919087290",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934037430",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934083930",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934030830",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804022230",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788365909",
      "ndc_label_name": "Levothyroxine Sodium TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772909",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335213806",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064290",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189020690",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024090",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788916403",
      "ndc_label_name": "Levothyroxine Sodium TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792903",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064230",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789011630",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789029730",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792909",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603066401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205001890",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804022290",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603066402",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162146200",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789011690",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024010",
      "ndc_label_name": "Levothyroxine Sodium Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039844",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480870401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378181110",
      "ndc_label_name": "Levothyroxine Sodium TABLET 112 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378181177",
      "ndc_label_name": "Levothyroxine Sodium TABLET 112 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480870498",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934038030",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292003920",
      "ndc_label_name": "Levothyroxine Sodium TABLET 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722028910",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267065130",
      "ndc_label_name": "Levothyroxine Sodium TABLET 112 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480870410",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328546",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781065490",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328543",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060590",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063094590",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039810",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722028990",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045215",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904695461",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090610301",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565500",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789011390",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090129500",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781065410",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050811",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039811",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045217",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788769701",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097009",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090129501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788769703",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090660200",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292003901",
      "ndc_label_name": "Levothyroxine Sodium TABLET 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788734901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024190",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090752600",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090688000",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022290",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090610300",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090752601",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050801",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162109100",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687900",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090752700",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267065190",
      "ndc_label_name": "Levothyroxine Sodium TABLET 112 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629208801",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097003",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097001",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788734909",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788734903",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189001490",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788769709",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024110",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183507",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603066501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 112 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773190",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090090300",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090698201",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781065790",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378181377",
      "ndc_label_name": "Levothyroxine Sodium TABLET 125 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328646",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090788501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378181310",
      "ndc_label_name": "Levothyroxine Sodium TABLET 125 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480870710",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079044320",
      "ndc_label_name": "Levothyroxine Sodium TABLET 125 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118134709",
      "ndc_label_name": "Levothyroxine Sodium TABLET 125 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090564401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480870798",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722029010",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788768909",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480870701",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328643",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919054930",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794503",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090698100",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039911",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999079501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205023230",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045317",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904695561",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794509",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603066601",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090698200",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781065710",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090698300",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804024630",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039910",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045315",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205023290",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090479901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687051911",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722029090",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090788500",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090786200",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090090301",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039944",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079044301",
      "ndc_label_name": "Levothyroxine Sodium TABLET 125 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919054990",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267023630",
      "ndc_label_name": "Levothyroxine Sodium TABLET 125 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063095690",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097103",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183601",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090479900",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999079500",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097109",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934084690",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788768903",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090564400",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183607",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090610000",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934038130",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788915603",
      "ndc_label_name": "Levothyroxine Sodium TABLET 125 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024210",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090610001",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024290",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934084630",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090788600",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959092000",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687051901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205054390",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205068130",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335228401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789011990",
      "ndc_label_name": "Levothyroxine Sodium Tablet 125 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480871001",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480871098",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328743",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378182377",
      "ndc_label_name": "Levothyroxine Sodium TABLET 137 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097201",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722029110",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045415",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378182310",
      "ndc_label_name": "Levothyroxine Sodium TABLET 137 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722029190",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342040044",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328746",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045417",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772001",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090579200",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342040010",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480871010",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292004101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090404501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781065990",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794403",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919031430",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342040011",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781065910",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292004120",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629918801",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687056301",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090123701",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794409",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788734801",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090123700",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517600",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090780200",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772009",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687056311",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090404500",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097203",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090517601",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090579201",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788734803",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162109200",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608900",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788734809",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090691900",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005090",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090776700",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629208901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090780100",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024310",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090780101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183701",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097209",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024390",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772003",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189025090",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183707",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603066701",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205035490",
      "ndc_label_name": "Levothyroxine Sodium Tablet 137 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090090500",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378181577",
      "ndc_label_name": "Levothyroxine Sodium TABLET 150 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378181510",
      "ndc_label_name": "Levothyroxine Sodium TABLET 150 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328843",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328846",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480871598",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480871510",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045517",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090610400",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773290",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045515",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342040111",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722029290",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722029210",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342040144",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999079601",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183807",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480871501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090462501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090688500",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342040110",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781066210",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999079600",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090090501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335228501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904695661",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090566900",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090763600",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079044501",
      "ndc_label_name": "Levothyroxine Sodium TABLET 150 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090462500",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090763601",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090688401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024490",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063095090",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090610401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079044520",
      "ndc_label_name": "Levothyroxine Sodium TABLET 150 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097309",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090566901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081030",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090763700",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788635303",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781066290",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090661000",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687053001",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788635306",
      "ndc_label_name": "Levothyroxine Sodium TABLET 150 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687053011",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934084830",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187085190",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603066801",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187085130",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090688400",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919097830",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804019030",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081090",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335976301",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017330",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097301",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934017990",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772409",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788915703",
      "ndc_label_name": "Levothyroxine Sodium TABLET 150 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795309",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097303",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934038230",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017390",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772403",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603066802",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795303",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024410",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183801",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934084890",
      "ndc_label_name": "Levothyroxine Sodium Tablet 150 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480871810",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480871898",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378181777",
      "ndc_label_name": "Levothyroxine Sodium TABLET 175 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328946",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378181710",
      "ndc_label_name": "Levothyroxine Sodium TABLET 175 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090611500",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045615",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045617",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904695761",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090588701",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328943",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342040211",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480871801",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097403",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342040244",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781066510",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788723203",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090756501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722029310",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353029660",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722029390",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788723209",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292004020",
      "ndc_label_name": "Levothyroxine Sodium TABLET 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781066590",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879303",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687054111",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342040210",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090183300",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090138900",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024510",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629209001",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090611501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097409",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292004001",
      "ndc_label_name": "Levothyroxine Sodium TABLET 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090663400",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687054101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776403",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090138901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090657600",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881106",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090183301",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090756500",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776409",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183907",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090588700",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090756600",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879309",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934052030",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881109",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603066901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162109300",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881103",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024590",
      "ndc_label_name": "Levothyroxine Sodium Tablet 175 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773390",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527329043",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480872210",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527329046",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378181910",
      "ndc_label_name": "Levothyroxine Sodium TABLET 200 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378181977",
      "ndc_label_name": "Levothyroxine Sodium TABLET 200 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045717",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090582102",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342040310",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722029410",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342040344",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722029490",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852109",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480872298",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090212803",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097503",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090582103",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781066810",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781066890",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009030",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788890203",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045715",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009008",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788770403",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090610503",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009000",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090610502",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055201",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238184001",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342040311",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009060",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162109400",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335228602",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009090",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097509",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335194002",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024690",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090212802",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788770409",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335228601",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034690",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629209101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238184007",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603070101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024610",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852103",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788890209",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335299401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189023390",
      "ndc_label_name": "Levothyroxine Sodium Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378180077",
      "ndc_label_name": "Levothyroxine Sodium TABLET 25 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904694961",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440772790",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722028490",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328046",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044715",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378180010",
      "ndc_label_name": "Levothyroxine Sodium TABLET 25 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480868210",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090494700",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480868201",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096630",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079044420",
      "ndc_label_name": "Levothyroxine Sodium TABLET 25 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039310",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044717",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096690",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480868298",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565100",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328043",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187057230",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772803",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796909",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039311",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090120600",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781064010",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090611600",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722028410",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267023430",
      "ndc_label_name": "Levothyroxine Sodium TABLET 25 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205051290",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335162501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039344",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090291100",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090790901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090683100",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781064090",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162145800",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162145802",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090120601",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090494701",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079044401",
      "ndc_label_name": "Levothyroxine Sodium TABLET 25 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090707100",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090120500",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096503",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603066001",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096509",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090345100",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090791000",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919078330",
      "ndc_label_name": "Levothyroxine Sodium TABLET 25 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183007",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090120501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687045301",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603066002",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934037830",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687045311",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864803",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183001",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934037890",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090611601",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864809",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789015030",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205051230",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081630",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022190",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023690",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335228701",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090786000",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023610",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789015090",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934026630",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804016890",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090790900",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022130",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081690",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335144707",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629871101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017430",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772809",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796903",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788916003",
      "ndc_label_name": "Levothyroxine Sodium TABLET 25 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934086430",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205038290",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804016830",
      "ndc_label_name": "Levothyroxine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342040444",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480872510",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527329146",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378182177",
      "ndc_label_name": "Levothyroxine Sodium TABLET 300 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480872598",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773490",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722029510",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342040411",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024790",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865024710",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342040410",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097603",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045815",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480872501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722029590",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097601",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629209401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781067110",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097609",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781067190",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238184101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162109500",
      "ndc_label_name": "Levothyroxine Sodium Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480868710",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328146",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722028510",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044815",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378180310",
      "ndc_label_name": "Levothyroxine Sodium TABLET 50 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480868701",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063095130",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378180377",
      "ndc_label_name": "Levothyroxine Sodium TABLET 50 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044817",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039410",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999079230",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722028590",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480868798",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904695061",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090566100",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328143",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039444",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999079200",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090656901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090282600",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090656900",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788769809",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046690",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039411",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781064390",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090657200",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700071730",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090609001",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079044020",
      "ndc_label_name": "Levothyroxine Sodium TABLET 50 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791103",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838203",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063095190",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090088500",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090659400",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096603",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666000",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959092100",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791109",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335150202",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781064310",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090088501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687046411",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838209",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079044001",
      "ndc_label_name": "Levothyroxine Sodium TABLET 50 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092490",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027290",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090566101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090609000",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096609",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934016630",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687046401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788916103",
      "ndc_label_name": "Levothyroxine Sodium TABLET 50 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183107",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023790",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700071790",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919040330",
      "ndc_label_name": "Levothyroxine Sodium TABLET 50 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934086730",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934016690",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092430",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934083690",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804009990",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934027330",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629871201",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096601",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010930",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934027390",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400503",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335961702",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014990",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934039830",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267012930",
      "ndc_label_name": "Levothyroxine Sodium TABLET 50 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788769803",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400509",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934039890",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335228801",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162145900",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335976201",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064690",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603066101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934083630",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010990",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804009930",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027230",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064630",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023710",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014930",
      "ndc_label_name": "Levothyroxine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039511",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480869098",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378180510",
      "ndc_label_name": "Levothyroxine Sodium TABLET 75 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328246",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090090101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378180577",
      "ndc_label_name": "Levothyroxine Sodium TABLET 75 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480869001",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440772990",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090090000",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904695161",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328243",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044915",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090462300",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729044917",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480869010",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565800",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205035390",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063094890",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722028610",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090682400",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090611800",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722028690",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781064610",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959092200",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162146000",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090090100",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039544",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154539500",
      "ndc_label_name": "Levothyroxine Sodium TABLET 75 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079044120",
      "ndc_label_name": "Levothyroxine Sodium TABLET 75 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039510",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183207",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959092230",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189010730",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565900",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781064690",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687047511",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795403",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565801",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335182701",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919019730",
      "ndc_label_name": "Levothyroxine Sodium TABLET 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795409",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090682500",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090090001",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919097530",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010490",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096709",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335228901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788916203",
      "ndc_label_name": "Levothyroxine Sodium TABLET 75 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804005390",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079044101",
      "ndc_label_name": "Levothyroxine Sodium TABLET 75 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090462301",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788889603",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162146003",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065530",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090611801",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023810",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162146009",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687047501",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090682401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788889609",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189007330",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603066201",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919097590",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934029230",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189007390",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096703",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096701",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162146006",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880603",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335203901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880609",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023890",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183201",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335296701",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934029290",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934041130",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189010790",
      "ndc_label_name": "Levothyroxine Sodium Tablet 75 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480869398",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045015",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729045017",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480869301",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722028710",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378180710",
      "ndc_label_name": "Levothyroxine Sodium TABLET 88 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039611",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090462400",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039644",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722028790",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090120800",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328343",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292003801",
      "ndc_label_name": "Levothyroxine Sodium TABLET 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378180777",
      "ndc_label_name": "Levothyroxine Sodium TABLET 88 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565300",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090495100",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090760900",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090120801",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090787100",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527328346",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608700",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480869310",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775909",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687048601",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090790100",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090462401",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096809",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292003820",
      "ndc_label_name": "Levothyroxine Sodium TABLET 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090760800",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904695261",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794303",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687048611",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919087030",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090495101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879209",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098990",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090790200",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342039610",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183301",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603066301",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919087090",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090698500",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934037930",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608701",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629209201",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781064910",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060490",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023910",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919097630",
      "ndc_label_name": "Levothyroxine Sodium TABLET 88 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090790101",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096801",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090760801",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187057330",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781064990",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180096803",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775901",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267023530",
      "ndc_label_name": "Levothyroxine Sodium TABLET 88 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775903",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708109",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934037990",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708103",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565301",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794309",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162109000",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879201",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090698400",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238183307",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794301",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205026190",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879203",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023990",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335229001",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789011490",
      "ndc_label_name": "Levothyroxine Sodium Tablet 88 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00113086626",
      "ndc_label_name": "Lice Killing Maximum Strength Shampoo 0.33-4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904252820",
      "ndc_label_name": "Lice Killing Maximum Strength Shampoo 0.33-4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000004101",
      "ndc_label_name": "Lice Treatment Creme Rinse Liquid 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135067299",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536128128",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536127803",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135067296",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "42291039930",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536135795",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536126720",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73715000101",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328002405",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71085007519",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328002455",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71085007560",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "47781057047",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328002415",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58980082430",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "47781057072",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71800002606",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328002430",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83720052301",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50488626201",
      "ndc_label_name": "Lidocaine CREAM 4 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "47781057073",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69375000530",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58980082405",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80425035101",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58980082415",
      "ndc_label_name": "Lidocaine Cream 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121097251",
      "ndc_label_name": "Lidocaine HCl Solution 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054350547",
      "ndc_label_name": "Lidocaine HCl SOLUTION 4 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135073651",
      "ndc_label_name": "Lidocaine HCl Solution 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407082550",
      "ndc_label_name": "Lidocaine HCl Solution 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527600480",
      "ndc_label_name": "Lidocaine HCl Solution 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672141103",
      "ndc_label_name": "Lidocaine HCl Solution 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162109802",
      "ndc_label_name": "Lidocaine HCl Solution 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00116402550",
      "ndc_label_name": "Lidocaine HCl Solution 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432046551",
      "ndc_label_name": "Lidocaine HCl Solution 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629209601",
      "ndc_label_name": "Lidocaine HCl Solution 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954051810",
      "ndc_label_name": "Lidocaine HCl Solution 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739099764",
      "ndc_label_name": "Lidocaine HCl Solution 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83148004350",
      "ndc_label_name": "Lidocaine HCl Solution 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679046550",
      "ndc_label_name": "Lidocaine HCl Solution 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679046551",
      "ndc_label_name": "Lidocaine HCl Solution 4 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071110",
      "ndc_label_name": "Lidocaine HCl Urethral/Mucosal Gel 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071131",
      "ndc_label_name": "Lidocaine HCl Urethral/Mucosal Gel 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071130",
      "ndc_label_name": "Lidocaine HCl Urethral/Mucosal Gel 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090055500",
      "ndc_label_name": "Lidocaine HCl Urethral/Mucosal Gel 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485061110",
      "ndc_label_name": "Lidocaine HCl Urethral/Mucosal Gel 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485061130",
      "ndc_label_name": "Lidocaine HCl Urethral/Mucosal Gel 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485061131",
      "ndc_label_name": "Lidocaine HCl Urethral/Mucosal Gel 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121097001",
      "ndc_label_name": "Lidocaine Pain Relief Max St Patch 4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121097030",
      "ndc_label_name": "Lidocaine Pain Relief Max St Patch 4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250097205",
      "ndc_label_name": "Lidocaine Pain Relief Max St Patch 4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121097005",
      "ndc_label_name": "Lidocaine Pain Relief Max St Patch 4 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16714017701",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591267911",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591352511",
      "ndc_label_name": "Lidocaine PATCH 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378905516",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603188010",
      "ndc_label_name": "Lidocaine PATCH 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436352501",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090785702",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378905593",
      "ndc_label_name": "Lidocaine PATCH 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017730",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591267930",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591352530",
      "ndc_label_name": "Lidocaine PATCH 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291047730",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603188016",
      "ndc_label_name": "Lidocaine PATCH 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760020130",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59088039682",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291049511",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291047711",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436133001",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858011830",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090789402",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291049530",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760065705",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919077930",
      "ndc_label_name": "Lidocaine PATCH 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700002530",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407082730",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700014230",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518092600",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59088039654",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090135902",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760088005",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425040401",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760020105",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629509402",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629247201",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335193405",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162208503",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700093230",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629509403",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335197105",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629509405",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162079104",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788715903",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032501",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420089930",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014130",
      "ndc_label_name": "Lidocaine PATCH 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335193403",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82347050505",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629875501",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335193406",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788761703",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919058830",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82461061115",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509288003",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82347050504",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162079108",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834403",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518056600",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518382100",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335193401",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335197103",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003730",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189038730",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82461061101",
      "ndc_label_name": "Lidocaine Patch 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121495015",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090566700",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856013802",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121090315",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054350049",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090025500",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856077502",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856077501",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090704000",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383036315",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788850701",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121495040",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121090340",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090618600",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383077504",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856077504",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687087064",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383077515",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959025100",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527600274",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121095003",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651094301",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919014032",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436182701",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788799901",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919052032",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267096200",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714009701",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383036317",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135087151",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383077517",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432046400",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687087044",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788884701",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135087124",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856013801",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629209501",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919024732",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999087151",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135071242",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888012526",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999087124",
      "ndc_label_name": "Lidocaine Viscous HCl Solution 2 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574204230",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168035755",
      "ndc_label_name": "Lidocaine-Prilocaine CREAM 2.5-2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168035730",
      "ndc_label_name": "Lidocaine-Prilocaine CREAM 2.5-2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574204205",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999052330",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591207026",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121100230",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574204213",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335271601",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922007605",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090658900",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591207030",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033002501",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071162503",
      "ndc_label_name": "Lidocaine-Prilocaine CREAM 2.5-2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335297001",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591207072",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033002550",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090119700",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383066730",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788815003",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162112503",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919044330",
      "ndc_label_name": "Lidocaine-Prilocaine CREAM 2.5-2.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033002505",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332058204",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629960401",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332058231",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033002551",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739005466",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512003030",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578016506",
      "ndc_label_name": "Lidocaine-Prilocaine Cream 2.5-2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00023585801",
      "ndc_label_name": "Liletta (52 MG) Intrauterine Device 20.1 MCG/DAY Intrauterine",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762130804",
      "ndc_label_name": "Linezolid Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054031950",
      "ndc_label_name": "Linezolid SUSPENSION RECONSTITUTED 100 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722086525",
      "ndc_label_name": "Linezolid Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762130801",
      "ndc_label_name": "Linezolid Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687075405",
      "ndc_label_name": "Linezolid Suspension Reconstituted 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877041920",
      "ndc_label_name": "Linezolid TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877041933",
      "ndc_label_name": "Linezolid Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904655304",
      "ndc_label_name": "Linezolid TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687030921",
      "ndc_label_name": "Linezolid TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332018320",
      "ndc_label_name": "Linezolid TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762130702",
      "ndc_label_name": "Linezolid TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762130701",
      "ndc_label_name": "Linezolid TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980056102",
      "ndc_label_name": "Linezolid Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980056103",
      "ndc_label_name": "Linezolid Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135044220",
      "ndc_label_name": "Linezolid Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722074920",
      "ndc_label_name": "Linezolid TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606000107",
      "ndc_label_name": "Linezolid Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877041901",
      "ndc_label_name": "Linezolid TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877041984",
      "ndc_label_name": "Linezolid TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722074930",
      "ndc_label_name": "Linezolid TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606000108",
      "ndc_label_name": "Linezolid Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687030911",
      "ndc_label_name": "Linezolid TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606000103",
      "ndc_label_name": "Linezolid Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714016701",
      "ndc_label_name": "Liothyronine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291041890",
      "ndc_label_name": "Liothyronine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794001906",
      "ndc_label_name": "Liothyronine Sodium TABLET 25 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093217801",
      "ndc_label_name": "Liothyronine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907000101",
      "ndc_label_name": "Liothyronine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794001912",
      "ndc_label_name": "Liothyronine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43063088430",
      "ndc_label_name": "Liothyronine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794001902",
      "ndc_label_name": "Liothyronine Sodium TABLET 25 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407038501",
      "ndc_label_name": "Liothyronine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756059088",
      "ndc_label_name": "Liothyronine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382058301",
      "ndc_label_name": "Liothyronine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862032101",
      "ndc_label_name": "Liothyronine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377011512",
      "ndc_label_name": "Liothyronine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762120701",
      "ndc_label_name": "Liothyronine Sodium Tablet 25 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714016601",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093217901",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090296900",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090751801",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862032001",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291041790",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788726903",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794001802",
      "ndc_label_name": "Liothyronine Sodium TABLET 5 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756058988",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090313101",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090751800",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407038401",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382058201",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794001806",
      "ndc_label_name": "Liothyronine Sodium TABLET 5 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907003901",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794001812",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788726906",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090558601",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788726909",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762120601",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377011412",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090313100",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090558600",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205015030",
      "ndc_label_name": "Liothyronine Sodium Tablet 5 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794002002",
      "ndc_label_name": "Liothyronine Sodium TABLET 50 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382058401",
      "ndc_label_name": "Liothyronine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093218001",
      "ndc_label_name": "Liothyronine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762120801",
      "ndc_label_name": "Liothyronine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377011612",
      "ndc_label_name": "Liothyronine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714016801",
      "ndc_label_name": "Liothyronine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291041990",
      "ndc_label_name": "Liothyronine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407038601",
      "ndc_label_name": "Liothyronine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794002012",
      "ndc_label_name": "Liothyronine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756059188",
      "ndc_label_name": "Liothyronine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75907000401",
      "ndc_label_name": "Liothyronine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862032201",
      "ndc_label_name": "Liothyronine Sodium Tablet 50 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11845012385",
      "ndc_label_name": "Liquid Calcium/Vitamin D Capsule 600-5 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629073500",
      "ndc_label_name": "Liquid Calcium/Vitamin D Capsule 600-5 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00480366720",
      "ndc_label_name": "Liraglutide Solution Pen-Injector 18 MG/3ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143914403",
      "ndc_label_name": "Liraglutide Solution Pen-Injector 18 MG/3ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71288056384",
      "ndc_label_name": "Liraglutide Solution Pen-Injector 18 MG/3ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097092067",
      "ndc_label_name": "Liraglutide Solution Pen-Injector 18 MG/3ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143914402",
      "ndc_label_name": "Liraglutide Solution Pen-Injector 18 MG/3ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480366722",
      "ndc_label_name": "Liraglutide Solution Pen-Injector 18 MG/3ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090750100",
      "ndc_label_name": "Liraglutide Solution Pen-Injector 18 MG/3ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71288056385",
      "ndc_label_name": "Liraglutide Solution Pen-Injector 18 MG/3ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70748034602",
      "ndc_label_name": "Liraglutide Solution Pen-Injector 18 MG/3ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097092068",
      "ndc_label_name": "Liraglutide Solution Pen-Injector 18 MG/3ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70748034603",
      "ndc_label_name": "Liraglutide Solution Pen-Injector 18 MG/3ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505473901",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781229901",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527466137",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858016101",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480356501",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378685477",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547060210",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054066025",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020601",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664004688",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245101",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722035001",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406511101",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850055001",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781056201",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245109",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406511201",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858016201",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378685577",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054037025",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664004788",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245203",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547060310",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527466237",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480356601",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781247601",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722035101",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245201",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687089611",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781056301",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291003690",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020701",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687089621",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505474001",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850055101",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245209",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162002309",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245401",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722035201",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406511301",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378685677",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054037125",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480356701",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687090711",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781247701",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858016301",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547060410",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781056401",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527466337",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850055201",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291003790",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664004888",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505474101",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162002409",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020801",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245403",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687090721",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245409",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162221601",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480356801",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245501",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527466437",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687091811",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406511401",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054037225",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291003890",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378685777",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781247801",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547060510",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858016401",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687091821",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020901",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781056501",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722035301",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664004988",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850055301",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162002509",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505474201",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245509",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480356901",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005088",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054037325",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547060610",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722035401",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505474301",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687092911",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378685877",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527466537",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245603",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245609",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850055401",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858016501",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406511501",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162002609",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687092921",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781247901",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781056601",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291003990",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010021001",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245601",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378685977",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005188",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858016601",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781248001",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406511601",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850055501",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054037425",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722035501",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480357001",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505474401",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527466637",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245701",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291004090",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687094011",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547060710",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781056701",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162002709",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687094021",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010021101",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245709",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722035601",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547060810",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378686077",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527466737",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054037525",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664005288",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406511701",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291004190",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858016701",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850055601",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781248101",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162002809",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480356401",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687095111",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781056801",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245801",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505474501",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687095121",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245809",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245803",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010021201",
      "ndc_label_name": "Lisdexamfetamine Dimesylate Capsule 70 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185061001",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767530",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904563946",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767581",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356069530",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767590",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904563943",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185061010",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591040701",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767585",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155087810",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904679861",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081214",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904563948",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729037717",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155087801",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090512003",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591040710",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722017710",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081212",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081293",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063076930",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063076912",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722041901",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072890",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722017701",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063076993",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081260",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353011345",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063076960",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081298",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063076998",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700047930",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722041910",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090512000",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081290",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030130",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030160",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298804",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081201",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687032501",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063076990",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090512001",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353011360",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041611",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090377403",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090512004",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081230",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003901",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353030145",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090702200",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041610",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090285100",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700051390",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090512005",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655039952",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003999",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547035310",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072830",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298801",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298803",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760039090",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072820",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030630",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001033408",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547035311",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002112300",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090377400",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090377404",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001033400",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700047900",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082160",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061245",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999018210",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002112306",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090377405",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002112303",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180098003",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030660",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003905",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073115",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298800",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458087410",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090722100",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934012030",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180098030",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074630",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763301",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865021010",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298805",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700051330",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072815",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934012090",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788640703",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074690",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934015590",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282041910",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090377401",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760035890",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030690",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074290",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788640706",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763306",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074230",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009006410",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090488500",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135064231",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180098001",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282041990",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788640709",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063815",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073130",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073010",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700047990",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082190",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645061090",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073050",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831001",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073180",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073145",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645055254",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687032511",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282041945",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788640701",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645058754",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831003",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831006",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865021045",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934020030",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760035830",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063880",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335053604",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073160",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061260",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073001",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063845",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073045",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135064290",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073090",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063860",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063830",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082130",
      "ndc_label_name": "Lisinopril TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304053301",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763303",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788763309",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831009",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934020090",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865021090",
      "ndc_label_name": "Lisinopril Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282041901",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282041950",
      "ndc_label_name": "Lisinopril TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080802",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722017205",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591040501",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729037501",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185060201",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185060210",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081001",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155087605",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304053101",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722041701",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722017201",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155087601",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591040505",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729019417",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547035110",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090243100",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788682006",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722041710",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645060890",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027060",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547035150",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353064360",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041410",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959097330",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072653",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080801",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788682001",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041450",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090243101",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135064090",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090686000",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003799",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074880",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687065621",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074130",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080800",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090243102",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078090",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788682003",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084076511",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282072801",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135064031",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010101",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919071790",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687065611",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180051202",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072630",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084076521",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078030",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629524701",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009006205",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001033203",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629882301",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180051230",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072645",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180051209",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003701",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629524702",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074870",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072670",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180051201",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645055054",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282041705",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072660",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074145",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629873601",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282072805",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074160",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074153",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934063330",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074180",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074170",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003705",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074830",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074175",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282041701",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001033200",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788682009",
      "ndc_label_name": "Lisinopril TABLET 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074853",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074860",
      "ndc_label_name": "Lisinopril Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185062001",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767645",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042010",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185062010",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904564048",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155087901",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767614",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767630",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767681",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767685",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063078690",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591040801",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729037817",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155087910",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027145",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767690",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904679961",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591040810",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063078693",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904564089",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081330",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722017801",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031315",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904564046",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063078660",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063078630",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081301",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081314",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031360",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722017810",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547035411",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042001",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063078698",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081398",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081393",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353029730",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547035410",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063078614",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472501",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081390",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041711",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353029745",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027130",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099380",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999018310",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081360",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090488700",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099330",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472503",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353029780",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027160",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072960",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090275300",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298901",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655041152",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099345",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002117803",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072930",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027180",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700048090",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298905",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298904",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072990",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099353",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002117806",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760035990",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353029760",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760035930",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002117800",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472500",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458087310",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099360",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760043890",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187044200",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099392",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760043830",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700048030",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077530",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687033301",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041710",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135064390",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077590",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472505",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919024630",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687033311",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783109",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077500",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298900",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180098101",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774606",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004099",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135064331",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077560",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001501",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004001",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090298903",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645053254",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835109",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783101",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304053401",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001033508",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001506",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001033500",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090472504",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788692001",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006130",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001509",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004005",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788692006",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001507",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180098103",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645061190",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774609",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205018030",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061645",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645055354",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835103",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073101",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180098130",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774603",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006190",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061660",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865021145",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788692009",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835106",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073190",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788692003",
      "ndc_label_name": "Lisinopril TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783106",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073315",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061680",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282042090",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788774601",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205018000",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009006510",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783103",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073330",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789009390",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282042018",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073110",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001504",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205018090",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073150",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835101",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073353",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073118",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073345",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001502",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073360",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001505",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282042050",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001503",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789009330",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865021110",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073145",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001508",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282042001",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865021190",
      "ndc_label_name": "Lisinopril Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282042010",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282042045",
      "ndc_label_name": "Lisinopril TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155088001",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282042101",
      "ndc_label_name": "Lisinopril TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185063010",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004199",
      "ndc_label_name": "Lisinopril TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155088005",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591088501",
      "ndc_label_name": "Lisinopril TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729037901",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722017905",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081401",
      "ndc_label_name": "Lisinopril TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042110",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729037917",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547035510",
      "ndc_label_name": "Lisinopril TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042101",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317500",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547035550",
      "ndc_label_name": "Lisinopril TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004105",
      "ndc_label_name": "Lisinopril TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041810",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135064490",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722017901",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645055454",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041850",
      "ndc_label_name": "Lisinopril TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001033600",
      "ndc_label_name": "Lisinopril TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090293402",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645061290",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317501",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205007190",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999087000",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090293400",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180098201",
      "ndc_label_name": "Lisinopril TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317502",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090293401",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135064431",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282042105",
      "ndc_label_name": "Lisinopril TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205007130",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919073690",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180098202",
      "ndc_label_name": "Lisinopril TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004101",
      "ndc_label_name": "Lisinopril TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180098230",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073205",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073201",
      "ndc_label_name": "Lisinopril Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729038017",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063048030",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767785",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185064010",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767781",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002146300",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767790",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904720061",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155088101",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063048090",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729038001",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591040901",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155088110",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001048600",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591040905",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018001",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018010",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063080030",
      "ndc_label_name": "Lisinopril TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042210",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904564289",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081560",
      "ndc_label_name": "Lisinopril TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645059354",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081530",
      "ndc_label_name": "Lisinopril TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035045",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063080090",
      "ndc_label_name": "Lisinopril TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081590",
      "ndc_label_name": "Lisinopril TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353000945",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722042201",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353000980",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733406",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353003730",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353066216",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081501",
      "ndc_label_name": "Lisinopril TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353000930",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353003780",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353000960",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035080",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733409",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547035610",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041911",
      "ndc_label_name": "Lisinopril TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353003760",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353066230",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090376300",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035030",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999046960",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062480",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700054730",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075300",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353066280",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090376301",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090707400",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035060",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919072130",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072745",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180051709",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002146303",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041910",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090630300",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458087210",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547035611",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004201",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282042210",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788701201",
      "ndc_label_name": "Lisinopril TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700054790",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999046910",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090630301",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035690",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999046990",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097903",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282042245",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027945",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067811",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090376302",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075360",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135064590",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090299000",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788701209",
      "ndc_label_name": "Lisinopril TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067801",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040660",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919072190",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090630302",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66685070604",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304053501",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090299002",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733403",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788701203",
      "ndc_label_name": "Lisinopril TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073301",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135064531",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959075330",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788701206",
      "ndc_label_name": "Lisinopril TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001048608",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090765000",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934045690",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027980",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097930",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082530",
      "ndc_label_name": "Lisinopril TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082590",
      "ndc_label_name": "Lisinopril TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031230",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645055554",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655029252",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027930",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031245",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934045630",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097901",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004299",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031280",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031253",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036030",
      "ndc_label_name": "Lisinopril TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062445",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072760",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072730",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645061390",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031260",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004205",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865021310",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282042201",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072780",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733401",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865021345",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027960",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073318",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062460",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865021390",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282042218",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282042290",
      "ndc_label_name": "Lisinopril TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073310",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009006610",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073345",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073390",
      "ndc_label_name": "Lisinopril Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767490",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722041810",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155087710",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155087701",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767485",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591040610",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722041801",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440767481",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904679761",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081101",
      "ndc_label_name": "Lisinopril TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999029500",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722017610",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041510",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904563889",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063007490",
      "ndc_label_name": "Lisinopril TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591040601",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063007430",
      "ndc_label_name": "Lisinopril TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090376503",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999029510",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356087930",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085420",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722017601",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002122503",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729037617",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353029830",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760035790",
      "ndc_label_name": "Lisinopril TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289088430",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081130",
      "ndc_label_name": "Lisinopril TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959097530",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353029845",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090990",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063081190",
      "ndc_label_name": "Lisinopril TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033345",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304053201",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012860",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547035211",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002122506",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079330",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135064131",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033330",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080903",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003899",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645060990",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041511",
      "ndc_label_name": "Lisinopril TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289088490",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080900",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681106",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547035210",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090222800",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180051330",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681109",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084019601",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135064190",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118051309",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796609",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090222801",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090222803",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796606",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766601",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180051303",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003801",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760038090",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856201",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090376500",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090691200",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003805",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053645",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180051309",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012853",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001033308",
      "ndc_label_name": "Lisinopril TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282072990",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687066711",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085430",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084019611",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076630",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766603",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180051301",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796603",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865020945",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919033230",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002122500",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856206",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076653",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856209",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458087710",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205062690",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282041801",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012815",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687066701",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282072910",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760045590",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061330",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012830",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282072945",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544012845",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681101",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001033300",
      "ndc_label_name": "Lisinopril TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205047130",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645055154",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766606",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681103",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058860",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796601",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766609",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934033830",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076660",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865020990",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856203",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282041845",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282041810",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061390",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282041890",
      "ndc_label_name": "Lisinopril TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205047190",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076680",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282072901",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009006310",
      "ndc_label_name": "Lisinopril Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591086001",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185710001",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090609400",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440768230",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999076100",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256500",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356077730",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086630",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063048230",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591086005",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090609401",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356077790",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999076130",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760096890",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073030",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042010",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063048290",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073060",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090683800",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042050",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090110701",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788815903",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606200",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090110700",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086660",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256502",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268047915",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268047911",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208600",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282044610",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700072490",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606201",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256501",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090606202",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407056405",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090630",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208601",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760086090",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180051801",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090775100",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004301",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097096807",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760058690",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760006390",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407056490",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047901",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822406",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919097090",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645055654",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038260",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097096812",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822403",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013715",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004305",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282044601",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822409",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822401",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180051802",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282044690",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282044605",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788815901",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788815906",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008004230",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788815909",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934025130",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047902",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788980703",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 10-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047903",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047904",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038230",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047905",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020703",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086580",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045830",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185015210",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185015201",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090263400",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440768360",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440768330",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090110900",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090110800",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353072680",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353072660",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591086101",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090620400",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045890",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591086105",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090110902",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030890",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042110",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090110901",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086560",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760006490",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090110801",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353056380",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407056590",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934012830",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042150",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052330",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090620401",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002290",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268048015",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999092490",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304053705",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335023001",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090263401",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052390",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407056505",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028402",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760086190",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090620402",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788807501",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282044705",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760051990",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788807509",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180051901",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037560",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004405",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675200",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788807506",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086880",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785101",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097096912",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785106",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189065130",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785103",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268048011",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788980903",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282044710",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825309",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002230",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788785109",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030830",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788807503",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028404",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097096907",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004401",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086860",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037460",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825301",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180051902",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825303",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083860",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934030330",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645055754",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825306",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083870",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205076330",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645058854",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335023003",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282044790",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028403",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335023002",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037480",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335023004",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028401",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027480",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037580",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083880",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083830",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282044701",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083853",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086760",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440768430",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185017301",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063046890",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185017310",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090603402",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959099730",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090297401",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999032130",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591086201",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591086205",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999032100",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063046830",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268048115",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004501",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090603400",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090297402",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353072260",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356077890",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090121800",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042210",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097990",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788815503",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407056605",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407056690",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090121900",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353065560",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090121802",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042250",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030930",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824109",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090090",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071015360",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090121902",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080060",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090121901",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090297400",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004505",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934071890",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097930",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071015390",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090603401",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090030",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268048111",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090697600",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934071830",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629373901",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030971",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788980803",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090729400",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071015330",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629373902",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180052001",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030990",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788815509",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824103",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934066830",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180052002",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038360",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097097112",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788815501",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645055854",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide TABLET 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788815506",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824101",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282044805",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824106",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097097107",
      "ndc_label_name": "Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282044801",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282044810",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282044890",
      "ndc_label_name": "Lisinopril-Hydrochlorothiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373271600",
      "ndc_label_name": "LiteTouch Mask Large",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373271500",
      "ndc_label_name": "LiteTouch Mask Medium",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373271400",
      "ndc_label_name": "LiteTouch Mask Small",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054852625",
      "ndc_label_name": "Lithium Carbonate CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332001331",
      "ndc_label_name": "Lithium Carbonate CAPSULE 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722054401",
      "ndc_label_name": "Lithium Carbonate CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462022001",
      "ndc_label_name": "Lithium Carbonate CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054252625",
      "ndc_label_name": "Lithium Carbonate CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544053470",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999073601",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722054510",
      "ndc_label_name": "Lithium Carbonate CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054252725",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769012",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054852725",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722054501",
      "ndc_label_name": "Lithium Carbonate CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090172201",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055770",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090391701",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687080601",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054252731",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769060",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629919001",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335100604",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090295900",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017301",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332001431",
      "ndc_label_name": "Lithium Carbonate CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687080611",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090279900",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187030490",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771609",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629191701",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332001491",
      "ndc_label_name": "Lithium Carbonate CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629191601",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771603",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462022101",
      "ndc_label_name": "Lithium Carbonate CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771606",
      "ndc_label_name": "Lithium Carbonate Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462022110",
      "ndc_label_name": "Lithium Carbonate CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017201",
      "ndc_label_name": "Lithium Carbonate Capsule 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462022201",
      "ndc_label_name": "Lithium Carbonate CAPSULE 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722054601",
      "ndc_label_name": "Lithium Carbonate CAPSULE 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332001531",
      "ndc_label_name": "Lithium Carbonate CAPSULE 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054253125",
      "ndc_label_name": "Lithium Carbonate CAPSULE 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155076301",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054002129",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378130001",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084064011",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054002125",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084064001",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378130005",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353089116",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629195501",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017182",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079018020",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980020501",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090605200",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090147000",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079018001",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980020505",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559034001",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462022301",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017101",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017130",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054002025",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378145001",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356050630",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090101",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090130",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090275400",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090299300",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291049601",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079014220",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980027801",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084065501",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084065511",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462022401",
      "ndc_label_name": "Lithium Carbonate ER Tablet Extended Release 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017401",
      "ndc_label_name": "Lithium Carbonate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054452731",
      "ndc_label_name": "Lithium Carbonate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756043088",
      "ndc_label_name": "Lithium Carbonate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054852825",
      "ndc_label_name": "Lithium Carbonate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054452725",
      "ndc_label_name": "Lithium Carbonate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353093509",
      "ndc_label_name": "Lithium Carbonate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756043018",
      "ndc_label_name": "Lithium Carbonate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094007762",
      "ndc_label_name": "Lithium Solution 8 MEQ/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71656007216",
      "ndc_label_name": "Lithium Solution 8 MEQ/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094007759",
      "ndc_label_name": "Lithium Solution 8 MEQ/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71656007205",
      "ndc_label_name": "Lithium Solution 8 MEQ/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71656007250",
      "ndc_label_name": "Lithium Solution 8 MEQ/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888017246",
      "ndc_label_name": "Lithium Solution 8 MEQ/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00310111030",
      "ndc_label_name": "Lokelma Packet 10 GM Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310111001",
      "ndc_label_name": "Lokelma Packet 10 GM Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310111039",
      "ndc_label_name": "Lokelma Packet 10 GM Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090650101",
      "ndc_label_name": "Lokelma Packet 10 GM Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090650100",
      "ndc_label_name": "Lokelma Packet 10 GM Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310110539",
      "ndc_label_name": "Lokelma Packet 5 GM Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310110530",
      "ndc_label_name": "Lokelma Packet 5 GM Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090650200",
      "ndc_label_name": "Lokelma Packet 5 GM Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310110501",
      "ndc_label_name": "Lokelma Packet 5 GM Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378210001",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999015515",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093031105",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378210005",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093031101",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440770508",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440770506",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904747261",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353064160",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090046003",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440770516",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289031515",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440770510",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353064153",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440770512",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268048215",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090046004",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090739800",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440770590",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289031520",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440770515",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090620800",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440770530",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959090515",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090620803",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090739803",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999015512",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651069101",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799060501",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289031506",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799060502",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154469900",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919042320",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079069001",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999015530",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687022911",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063002012",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289031508",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090046000",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289031510",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919042330",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407099901",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090739804",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105060950",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090285900",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289031512",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090620804",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267013212",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105060906",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959090520",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407099905",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544070053",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268048211",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746078101",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079069020",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095053",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267013220",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105060910",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651069105",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452027120",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289031530",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687022901",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746078105",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578013805",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544070031",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095030",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105060915",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064853",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629874701",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603032801",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105060903",
      "ndc_label_name": "Loperamide HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603032802",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095060",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064860",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610095080",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610078160",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452027130",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097353",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544070060",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097360",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888013001",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888013005",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610078153",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578013801",
      "ndc_label_name": "Loperamide HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090046100",
      "ndc_label_name": "Loperamide HCl Liquid 1 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68071132704",
      "ndc_label_name": "Loperamide HCl Liquid 1 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68094010859",
      "ndc_label_name": "Loperamide HCl Suspension 1 MG/7.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800064526",
      "ndc_label_name": "Loperamide HCl Suspension 1 MG/7.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49781006104",
      "ndc_label_name": "Loperamide HCl Suspension 1 MG/7.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00363064534",
      "ndc_label_name": "Loperamide HCl Suspension 1 MG/7.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49781008904",
      "ndc_label_name": "Loperamide HCl Suspension 1 MG/7.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113064526",
      "ndc_label_name": "Loperamide HCl Suspension 1 MG/7.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68094010862",
      "ndc_label_name": "Loperamide HCl Suspension 1 MG/7.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00363064526",
      "ndc_label_name": "Loperamide HCl Suspension 1 MG/7.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68788895101",
      "ndc_label_name": "Loperamide HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113222468",
      "ndc_label_name": "Loperamide HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788839302",
      "ndc_label_name": "Loperamide HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113222462",
      "ndc_label_name": "Loperamide HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205007912",
      "ndc_label_name": "Loperamide HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788895102",
      "ndc_label_name": "Loperamide HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788875002",
      "ndc_label_name": "Loperamide HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660012324",
      "ndc_label_name": "Loperamide HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788895103",
      "ndc_label_name": "Loperamide HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58602070176",
      "ndc_label_name": "Loperamide HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788895106",
      "ndc_label_name": "Loperamide HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33261090801",
      "ndc_label_name": "Loratadine Childrens Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230032224",
      "ndc_label_name": "Loratadine Childrens Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121084910",
      "ndc_label_name": "Loratadine Childrens Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121084940",
      "ndc_label_name": "Loratadine Childrens Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672213108",
      "ndc_label_name": "Loratadine Childrens Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904676720",
      "ndc_label_name": "Loratadine Childrens Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090751600",
      "ndc_label_name": "Loratadine Childrens Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904663220",
      "ndc_label_name": "Loratadine Childrens Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788826601",
      "ndc_label_name": "Loratadine Childrens Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800009208",
      "ndc_label_name": "Loratadine Childrens Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672209208",
      "ndc_label_name": "Loratadine Childrens Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230032212",
      "ndc_label_name": "Loratadine Childrens Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788702701",
      "ndc_label_name": "Loratadine Childrens Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904685207",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904685289",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440771090",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440771010",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00067067430",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904685260",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440771030",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440771003",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16714089803",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135076330",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904685272",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090083606",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904742646",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135076303",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904685261",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135076390",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056229",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16571082203",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904751161",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090553204",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49614017060",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16571082201",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904742659",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16714089802",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43353025960",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802065075",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43063067220",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959074030",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090083700",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16571082230",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16714089801",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49614017072",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802065065",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999022920",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43353025918",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289072815",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090083801",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43353025909",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802065078",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090083805",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49614017013",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090083605",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43353025930",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55700009730",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090083803",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090083800",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802065087",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090346400",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090083601",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090083806",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999022910",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187060114",
      "ndc_label_name": "Loratadine TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090083804",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268048911",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999022990",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090715800",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090083604",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090414805",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090430004",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187060160",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090414800",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53002074910",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090083600",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090775304",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090083900",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090430000",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090431600",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788765305",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090553205",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53002074915",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090083603",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50436350102",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090414804",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090706604",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090670104",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788834901",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268048915",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61919014230",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090414803",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51079024620",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090553200",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090775205",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090750804",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788861403",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959074010",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001043804",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090550604",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660052669",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090775204",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51079024601",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289072810",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788861409",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289072830",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001043816",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090710804",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959074014",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53002074920",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289072860",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58602070221",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788861600",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60505014708",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68084024801",
      "ndc_label_name": "Loratadine TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090750704",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959074020",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289072820",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58602070219",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187060110",
      "ndc_label_name": "Loratadine TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230032330",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61919014290",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788861603",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090775200",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53002074930",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289072890",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58602070240",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788401600",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230032333",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788834905",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788862800",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959074015",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58602070238",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55700009790",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60760083100",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788861405",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70934046730",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788860503",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788862801",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59564025130",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58602070284",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58602070204",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001043800",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788862809",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335010003",
      "ndc_label_name": "Loratadine TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788860509",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788862803",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61919014210",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629132902",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59564025110",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68084024811",
      "ndc_label_name": "Loratadine TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788865901",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335165101",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788861401",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788862905",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629132904",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629132903",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61919014207",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788834900",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230032334",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789034787",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788862805",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335010001",
      "ndc_label_name": "Loratadine TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629132905",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267065330",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629132901",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788861608",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335010006",
      "ndc_label_name": "Loratadine TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788401603",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788862903",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335010007",
      "ndc_label_name": "Loratadine TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267065314",
      "ndc_label_name": "Loratadine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788401609",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788401601",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788862909",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335010008",
      "ndc_label_name": "Loratadine TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788765300",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788865903",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335165104",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001043896",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788765309",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788765301",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335010004",
      "ndc_label_name": "Loratadine TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335010009",
      "ndc_label_name": "Loratadine TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788834909",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70934046797",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789034714",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001043897",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788860505",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788765303",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335010005",
      "ndc_label_name": "Loratadine TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335239101",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788861400",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335010002",
      "ndc_label_name": "Loratadine TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789034720",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788401605",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788861609",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788860500",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335165109",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789034730",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70010016201",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71610042360",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80425035201",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788834903",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518139901",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788861601",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335239102",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789034790",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518139904",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162232302",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335165105",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788860501",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335165107",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788865900",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71610055360",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788861605",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789038015",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788865909",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788862900",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70010016234",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788862901",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70934077930",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788865905",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335165102",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70518139903",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162232306",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70934046790",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70934077990",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335165103",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335165106",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335165108",
      "ndc_label_name": "Loratadine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72888002911",
      "ndc_label_name": "Loratadine Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72888002909",
      "ndc_label_name": "Loratadine Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536136707",
      "ndc_label_name": "Loratadine Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904583315",
      "ndc_label_name": "Loratadine-D 24HR Tablet Extended Release 24 Hour 10-240 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "35356060210",
      "ndc_label_name": "Loratadine-D 24HR Tablet Extended Release 24 Hour 10-240 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904583348",
      "ndc_label_name": "Loratadine-D 24HR Tablet Extended Release 24 Hour 10-240 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00054353244",
      "ndc_label_name": "LORazepam Intensol CONCENTRATE 2 MG/ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342510",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107008305",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090257600",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342505",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407099601",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053810",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342501",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107008301",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904600760",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077830",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090356700",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904600761",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053820",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006202",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289040230",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053890",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090346200",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687082011",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053800",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063005706",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053830",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267013360",
      "ndc_label_name": "LORazepam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006260",
      "ndc_label_name": "LORazepam TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304077210",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289040290",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304077201",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125090401",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559019505",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053840",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544019145",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014360",
      "ndc_label_name": "LORazepam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544019130",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687062711",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000845",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544019110",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544019192",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053860",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544019153",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304077205",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735501",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135086101",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019955",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544019160",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788748008",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687062701",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735503",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980062750",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735506",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125090405",
      "ndc_label_name": "LORazepam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022515",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544019180",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016630",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687082001",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788748009",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544019120",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335145504",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544019170",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022520",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315090405",
      "ndc_label_name": "LORazepam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032903",
      "ndc_label_name": "LORazepam TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006290",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315090401",
      "ndc_label_name": "LORazepam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544019175",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000880",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788748001",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022545",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022830",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032905",
      "ndc_label_name": "LORazepam TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014330",
      "ndc_label_name": "LORazepam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315090410",
      "ndc_label_name": "LORazepam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735508",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019980",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788748006",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076445",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032906",
      "ndc_label_name": "LORazepam TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000810",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187057603",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022815",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735509",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076428",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016610",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082710",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032908",
      "ndc_label_name": "LORazepam TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000860",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125090410",
      "ndc_label_name": "LORazepam TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032902",
      "ndc_label_name": "LORazepam TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016602",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035595",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016615",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082728",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335145503",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000892",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980062701",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032904",
      "ndc_label_name": "LORazepam TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000815",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420064760",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032901",
      "ndc_label_name": "LORazepam TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420064701",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019910",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019975",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544019115",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032907",
      "ndc_label_name": "LORazepam TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000853",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019992",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000875",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000830",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019915",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022528",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788748003",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019920",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000870",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022553",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022560",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022575",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019970",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065420",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205075610",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022580",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019930",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065460",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065410",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035130",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022570",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065470",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205075615",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065492",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019960",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076453",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065415",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076475",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065428",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076492",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000820",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082770",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022510",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035560",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065445",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420064790",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065453",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019945",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022530",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019953",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065475",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065480",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065430",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076470",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076480",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082720",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076410",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082745",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082715",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035102",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076415",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035160",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082730",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035590",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076420",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082753",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076430",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082775",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076460",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035530",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082760",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082780",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082792",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023630",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420064730",
      "ndc_label_name": "LORazepam Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904600860",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591024105",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904600861",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004804",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342601",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025460",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107008401",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090027202",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107008499",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107008405",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025415",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090281000",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342605",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090550801",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004806",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090550800",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012214",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063004815",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025470",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090419100",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342610",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407099701",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025430",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090556202",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090027300",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025480",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090550802",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090550900",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025453",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033121",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012201",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033145",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090556200",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090556300",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033115",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033104",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033100",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033140",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090027200",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033190",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090556201",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033130",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033120",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033105",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033110",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033160",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090027201",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048708",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048706",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048702",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048709",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033114",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048730",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700074505",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048720",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700096530",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048715",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048760",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919058430",
      "ndc_label_name": "LORazepam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048704",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687035501",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060760",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048779",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304077305",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048798",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700074530",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060703",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687083111",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687035511",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304077301",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048790",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304077310",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760051630",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125090505",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125090510",
      "ndc_label_name": "LORazepam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060790",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060730",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026120",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063801",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026155",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125090501",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026130",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267083515",
      "ndc_label_name": "LORazepam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559019610",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135086201",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026153",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063811",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788742808",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026115",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026180",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026110",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187053606",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012210",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788742801",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687083101",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315090501",
      "ndc_label_name": "LORazepam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026175",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012230",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026145",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980062850",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012280",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022980",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980062801",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315090510",
      "ndc_label_name": "LORazepam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026192",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022960",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205023505",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026170",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012292",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082855",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267042720",
      "ndc_label_name": "LORazepam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335169405",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788742803",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082870",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012260",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315090505",
      "ndc_label_name": "LORazepam TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022930",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789022606",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026160",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012253",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788742806",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789022630",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022945",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012215",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022970",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035630",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205023530",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022975",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788742809",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046502",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022955",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012220",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025510",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025555",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335146701",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012255",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335169401",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025560",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025528",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025515",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025575",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067455",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012228",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025570",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012270",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067470",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025545",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067428",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067410",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035660",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012245",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067430",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022915",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082845",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067460",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082860",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067415",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789022604",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012275",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035690",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022953",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035695",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082810",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082815",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022910",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025530",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082853",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082828",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025553",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025580",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082875",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067445",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067453",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082830",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082892",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082880",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789022615",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046501",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035601",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046503",
      "ndc_label_name": "LORazepam Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025515",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342710",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025530",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440772230",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342701",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342705",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107008501",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440772260",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025545",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959036515",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025560",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107008505",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904600960",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025580",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025592",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440772290",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025553",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687084211",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025570",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687064911",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090274800",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559019701",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959036590",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904600961",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025590",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125090601",
      "ndc_label_name": "LORazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025575",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687084201",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407099801",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980062901",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125090610",
      "ndc_label_name": "LORazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090351000",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959036530",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076860",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017815",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267060830",
      "ndc_label_name": "LORazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959036505",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544014253",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980062950",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959036501",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135086301",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076870",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084230",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544014215",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959036560",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315090610",
      "ndc_label_name": "LORazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610060030",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687064901",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544014230",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084280",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035795",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544014270",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304077401",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065553",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610060070",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304077405",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017860",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789033930",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065560",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315090605",
      "ndc_label_name": "LORazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017853",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084215",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035760",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304077410",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084270",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084253",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610060053",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017830",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035730",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084260",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610060060",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64125090605",
      "ndc_label_name": "LORazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076830",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017845",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789035790",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544014245",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789037610",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017870",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544014260",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065530",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315090601",
      "ndc_label_name": "LORazepam TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065570",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017880",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076853",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084245",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019730",
      "ndc_label_name": "LORazepam Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011510",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788010210",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107019790",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011530",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300014619",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788010230",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054012522",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342004607",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090265601",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342004610",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070210",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011590",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291042410",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107019730",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704961",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090340301",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080890",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036203",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571011210",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063095430",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063088130",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070290",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788010290",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090471200",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380093505",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036209",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237020690",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090323100",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005760",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090265600",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107019799",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090533700",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380093508",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090471201",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919095230",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090491400",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353029960",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919087790",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070230",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268050615",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180037803",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090604401",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002990",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033590",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090340300",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002991",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342004644",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033530",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180037806",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237020699",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080830",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934065730",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033510",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187070830",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571011290",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919087730",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766403",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739069810",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013716",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862020390",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187070890",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629242801",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036211",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084034801",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766406",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766409",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818601",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084034811",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818603",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380093504",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090340302",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180037809",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335158005",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205010230",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818606",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013706",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019490",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862020330",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090340901",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645052670",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017130",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610041560",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010074310",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010074303",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031790",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818609",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090471202",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010074309",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189009790",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046560",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017160",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205010290",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004490",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008330",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090604400",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019430",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789016590",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603034201",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023060",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023030",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268050611",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205014330",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189009730",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205014399",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002930",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004430",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603034202",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865014310",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862020399",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865014390",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013710",
      "ndc_label_name": "Losartan Potassium TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009004410",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766401",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934065790",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335158003",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008360",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046530",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162169800",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031730",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205014390",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865014330",
      "ndc_label_name": "Losartan Potassium Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704761",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788010030",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011390",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107019599",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788010010",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342004444",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300014419",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054012322",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090464501",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788010090",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342004407",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011310",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107019590",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262201",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070005",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070010",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090779402",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107019530",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036011",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036009",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090562600",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090464500",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070090",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090788800",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033390",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342004410",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262202",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262200",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090671400",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046130",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291042210",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268050411",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380093305",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571011090",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033310",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090464502",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090779400",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739067310",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571011010",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002790",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380093308",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090562601",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187035790",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071085730",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237020490",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380093304",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090540601",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400705",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180037603",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090562602",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862020190",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084034601",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002730",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013506",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090779401",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757001",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013516",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862020199",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084034611",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773701",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002791",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645052470",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268050415",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026045",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400701",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180037609",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013510",
      "ndc_label_name": "Losartan Potassium TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773706",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757009",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400703",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237020499",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037030",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757003",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757006",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335158201",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015545",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010074103",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773603",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629242601",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043945",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773609",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022690",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015560",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022460",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010074110",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773605",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400706",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043960",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773709",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026060",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022445",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022480",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006545",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773606",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400709",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189030390",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863906",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037045",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789016390",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189010090",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610006560",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773703",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788757005",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205014190",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863909",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043930",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865014190",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002990",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015530",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773705",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788773601",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865014130",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026030",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189008230",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863901",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863903",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022430",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863905",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061630",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010074109",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043915",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061690",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022630",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006930",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205014199",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006990",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610041745",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603034002",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002914",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162169600",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789028230",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603034001",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009004210",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002930",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865014110",
      "ndc_label_name": "Losartan Potassium Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291042310",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788010110",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054012422",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904704861",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788010130",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300014519",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107019690",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070190",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085460",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788010190",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668040930",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668040990",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107019630",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353072945",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070130",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090288200",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090548002",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668040910",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070110",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342004507",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107019699",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187083090",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342004510",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090448900",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268050511",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571011190",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353072960",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342004544",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090448901",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071151709",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090116400",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033410",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002890",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085490",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033430",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090548000",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090448902",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645058654",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090116401",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760078630",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084034701",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353072930",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760012590",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090548001",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237020590",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818901",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090288201",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003030",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010074209",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036103",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002830",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268050515",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003090",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010074210",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033490",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187083030",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335018101",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036109",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862020290",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760064530",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187029630",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205028190",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002891",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862020230",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335018102",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036111",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862020299",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760064590",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629242701",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069802",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187029690",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013610",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026203",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237020599",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071088430",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766503",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084034711",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008230",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629919201",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716701",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335110202",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760078690",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645059954",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791403",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788403701",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020745",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380093404",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716706",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335110205",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919086490",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818906",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818909",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791409",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024130",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380093405",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766509",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020760",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039190",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026201",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934062790",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788971203",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380093408",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180037709",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010074203",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024160",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180037703",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069801",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205028130",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205021230",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180037706",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013606",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026202",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205014299",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788403703",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000930",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026205",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205021290",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788403706",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013616",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046630",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009004310",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716709",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000945",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162169700",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020730",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766501",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788403709",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205014230",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024145",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818903",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000960",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335018103",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044030",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335018104",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716703",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610041845",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008260",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044015",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766506",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205014290",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028230",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603034102",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791401",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865014290",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028260",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791406",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044045",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934062730",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865014210",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205059890",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335018105",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026204",
      "ndc_label_name": "Losartan Potassium TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008245",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028245",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603034101",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789016490",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017990",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865014230",
      "ndc_label_name": "Losartan Potassium Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033830",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714022402",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093736956",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011710",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714022401",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093736910",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042509",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093736998",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004930",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300019110",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714022403",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090596000",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005107",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005144",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004991",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011730",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862046990",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300019119",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090596002",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237020899",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005110",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291050310",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187091890",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011790",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863209",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042511",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033810",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919078590",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042503",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090596001",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629243101",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291050390",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189029090",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090174501",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681201",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919079790",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090174500",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118011709",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862046930",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090174502",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118011703",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033890",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205025690",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681206",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004990",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681209",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180021603",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237020890",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180021609",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162231503",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266201",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170000",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162246103",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863203",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180021606",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919079730",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189032790",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189032730",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335304801",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162249200",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863201",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162231509",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863206",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862046999",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162231500",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804010390",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162249209",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788681203",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335282701",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162246100",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162246109",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189009890",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189016730",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189016790",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042403",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093736856",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005207",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093736898",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093736810",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011830",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090705802",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714022501",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042409",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300019219",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005244",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300019210",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011810",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714022504",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919087390",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291050410",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164101",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005210",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042411",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090444702",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714022502",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291050490",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788645201",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090663600",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164102",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090164100",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090593702",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090499300",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090499301",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090499302",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189032690",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090705801",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090705800",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090444700",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090719900",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118011803",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237020999",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090593701",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008008690",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090766400",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760047290",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090444701",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090782100",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118011809",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028990",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033910",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237020990",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919095490",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629243001",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090593700",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332005090",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332005091",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862047030",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760057290",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862047090",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788645206",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862047099",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090705900",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180021706",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919095430",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788645203",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033930",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170100",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332005030",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189032630",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033990",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788645209",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180021703",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180021709",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 100-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067160",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 100-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118011609",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093736798",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011610",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005010",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300019019",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300019010",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093736710",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093736756",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004890",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714022602",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011630",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291050290",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313500",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042311",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005044",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714022601",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862046830",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005007",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011690",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098630",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343011699",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090263202",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087330",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291050210",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851001",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042303",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714022604",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090121001",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237020790",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090514100",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090263201",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090596202",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851006",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090121000",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042309",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090263200",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033710",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237020799",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090686200",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343011630",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162246200",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090514101",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090596201",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343011690",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033730",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746033790",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180021503",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118011603",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189001290",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090596200",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788632903",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862046899",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004090",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818701",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851009",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004030",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012990",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090723700",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788632906",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180021509",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039430",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004830",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162246209",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004891",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189032530",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039490",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775801",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775803",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788632901",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629242901",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804023930",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862046890",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775809",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788632909",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818703",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818709",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788851003",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180021506",
      "ndc_label_name": "Losartan Potassium-HCTZ TABLET 50-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189029790",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818706",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189032590",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162246203",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789016230",
      "ndc_label_name": "Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769230",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093092606",
      "ndc_label_name": "Lovastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669230",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256300",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093092610",
      "ndc_label_name": "Lovastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090256301",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669285",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669260",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326800",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063049330",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769260",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629358301",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669200",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458084616",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090339601",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669281",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442014101",
      "ndc_label_name": "Lovastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090075700",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090075701",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046701",
      "ndc_label_name": "Lovastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669201",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458093816",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407025160",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326801",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705606",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959097400",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919031190",
      "ndc_label_name": "Lovastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046703",
      "ndc_label_name": "Lovastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407025110",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629119101",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959097430",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407025190",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828701",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002138500",
      "ndc_label_name": "Lovastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629101803",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442014110",
      "ndc_label_name": "Lovastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629117801",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173902",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001031400",
      "ndc_label_name": "Lovastatin TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442014160",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828706",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002138503",
      "ndc_label_name": "Lovastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629101806",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081490",
      "ndc_label_name": "Lovastatin TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629358302",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173904",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828703",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629101804",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099255",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081430",
      "ndc_label_name": "Lovastatin TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629101809",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046707",
      "ndc_label_name": "Lovastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629358303",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173907",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099230",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828709",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173909",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629101805",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705609",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173900",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705601",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046709",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099260",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173905",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099200",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705603",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099211",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099290",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173906",
      "ndc_label_name": "Lovastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093057610",
      "ndc_label_name": "Lovastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669301",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093057606",
      "ndc_label_name": "Lovastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185007260",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185007210",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069290",
      "ndc_label_name": "Lovastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769360",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185007201",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669385",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090075900",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669381",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769330",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669300",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098330",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069295",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669330",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069293",
      "ndc_label_name": "Lovastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407025290",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063069230",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407025260",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669360",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072030",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999047060",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999047030",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090388102",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458087110",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407025210",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919054790",
      "ndc_label_name": "Lovastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458084516",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442014210",
      "ndc_label_name": "Lovastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090075902",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999047090",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002057030",
      "ndc_label_name": "Lovastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934075090",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458093716",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919067671",
      "ndc_label_name": "Lovastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919054730",
      "ndc_label_name": "Lovastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090388100",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442014201",
      "ndc_label_name": "Lovastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046803",
      "ndc_label_name": "Lovastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919054771",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002057000",
      "ndc_label_name": "Lovastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289088130",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934041530",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001031500",
      "ndc_label_name": "Lovastatin TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046807",
      "ndc_label_name": "Lovastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187076590",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099300",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832601",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832603",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289088190",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099360",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046805",
      "ndc_label_name": "Lovastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046801",
      "ndc_label_name": "Lovastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099311",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001031508",
      "ndc_label_name": "Lovastatin TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645056690",
      "ndc_label_name": "Lovastatin TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832609",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099390",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099330",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832606",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205044030",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099355",
      "ndc_label_name": "Lovastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093092806",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669400",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185007410",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093092810",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669481",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071845",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769460",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669485",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054830",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669430",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185007460",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999047100",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054895",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289069290",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054890",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063093930",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071860",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440669460",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440769430",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442014310",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353076345",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056130",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090076200",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090076102",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321602",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054814",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407025390",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544022580",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090076202",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056190",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407025360",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407025310",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002117700",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099545",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458084416",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046907",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321600",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046903",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458087010",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289069214",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002117703",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090076100",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442014301",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289069230",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544022545",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934065890",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458093616",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544022553",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118046903",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001031608",
      "ndc_label_name": "Lovastatin TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544022515",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788823203",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645056790",
      "ndc_label_name": "Lovastatin TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077553",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001031600",
      "ndc_label_name": "Lovastatin TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788918203",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056160",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099400",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046905",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934065830",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019930",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077530",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788966803",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039645",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544022530",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077580",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077545",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099411",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099430",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544022560",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099455",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099490",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099460",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046901",
      "ndc_label_name": "Lovastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004501",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019990",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077560",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070945",
      "ndc_label_name": "Lovastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850089101",
      "ndc_label_name": "Loxapine Succinate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591037001",
      "ndc_label_name": "Loxapine Succinate CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135058601",
      "ndc_label_name": "Loxapine Succinate CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527139501",
      "ndc_label_name": "Loxapine Succinate CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135049360",
      "ndc_label_name": "Loxapine Succinate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090309900",
      "ndc_label_name": "Loxapine Succinate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573043702",
      "ndc_label_name": "Loxapine Succinate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090345700",
      "ndc_label_name": "Loxapine Succinate Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135058701",
      "ndc_label_name": "Loxapine Succinate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591037101",
      "ndc_label_name": "Loxapine Succinate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527139601",
      "ndc_label_name": "Loxapine Succinate CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850089201",
      "ndc_label_name": "Loxapine Succinate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573043802",
      "ndc_label_name": "Loxapine Succinate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591036901",
      "ndc_label_name": "Loxapine Succinate CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850089001",
      "ndc_label_name": "Loxapine Succinate Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135058501",
      "ndc_label_name": "Loxapine Succinate CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527139401",
      "ndc_label_name": "Loxapine Succinate CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804005130",
      "ndc_label_name": "Loxapine Succinate Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573043602",
      "ndc_label_name": "Loxapine Succinate Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135049260",
      "ndc_label_name": "Loxapine Succinate Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591037201",
      "ndc_label_name": "Loxapine Succinate CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527139701",
      "ndc_label_name": "Loxapine Succinate CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135058801",
      "ndc_label_name": "Loxapine Succinate CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850089301",
      "ndc_label_name": "Loxapine Succinate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573043902",
      "ndc_label_name": "Loxapine Succinate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70000001701",
      "ndc_label_name": "Lubricant Eye Drops (PF) Solution 0.4-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917014647",
      "ndc_label_name": "Lubricant Eye Drops PF SOLUTION 0.5 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536138792",
      "ndc_label_name": "Lubricant Eye Drops PF Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917016480",
      "ndc_label_name": "Lubricant Eye Drops PF SOLUTION 0.5 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917016481",
      "ndc_label_name": "Lubricant Eye Drops PF SOLUTION 0.5 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536138793",
      "ndc_label_name": "Lubricant Eye Drops PF Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000001202",
      "ndc_label_name": "Lubricant Eye Drops PF Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000001201",
      "ndc_label_name": "Lubricant Eye Drops PF Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917016865",
      "ndc_label_name": "Lubricant Eye Drops SOLUTION 0.4-0.3 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011597",
      "ndc_label_name": "Lubricant Eye Drops SOLUTION 0.4-0.3 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917020167",
      "ndc_label_name": "Lubricant Eye Drops Solution 0.4-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917016843",
      "ndc_label_name": "Lubricant Eye Drops SOLUTION 0.4-0.3 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015801",
      "ndc_label_name": "Lubricant Eye Drops SOLUTION 0.4-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268012615",
      "ndc_label_name": "Lubricant Eye Drops Solution 0.4-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000045502",
      "ndc_label_name": "Lubricant Eye Drops Solution 0.4-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917017726",
      "ndc_label_name": "Lubricant Eye Drops SOLUTION 0.4-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000045501",
      "ndc_label_name": "Lubricant Eye Drops Solution 0.4-0.3 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000009002",
      "ndc_label_name": "Lubricant Eye Drops Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "42494044805",
      "ndc_label_name": "Lubricant Eye Drops Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917014653",
      "ndc_label_name": "Lubricant Eye Drops SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917010556",
      "ndc_label_name": "Lubricant Eye Drops SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000070501",
      "ndc_label_name": "Lubricant Eye Drops Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917014382",
      "ndc_label_name": "Lubricant Eye Drops SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000070502",
      "ndc_label_name": "Lubricant Eye Drops Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000009001",
      "ndc_label_name": "Lubricant Eye Drops Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71406012435",
      "ndc_label_name": "Lubricant PM Ointment Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629889701",
      "ndc_label_name": "Lubricant PM Ointment Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10055097000",
      "ndc_label_name": "Lucira COVID-19 All-In-One Kit In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074228203",
      "ndc_label_name": "Lupron Depot-Ped (1-Month) KIT 11.25 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00074244003",
      "ndc_label_name": "Lupron Depot-Ped (1-Month) KIT 15 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00074210803",
      "ndc_label_name": "Lupron Depot-Ped (1-Month) KIT 7.5 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00074377903",
      "ndc_label_name": "Lupron Depot-Ped (3-Month) Kit 11.25 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00074969403",
      "ndc_label_name": "Lupron Depot-Ped (3-Month) Kit 30 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76336008060",
      "ndc_label_name": "Lysodren Tablet 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60258017201",
      "ndc_label_name": "Mag-G Tablet 500 (27 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10006070013",
      "ndc_label_name": "MagDelay Tablet Delayed Release 64 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015462",
      "ndc_label_name": "Magnesium Citrate SOLUTION 1.745 GM/30ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00363066738",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917010656",
      "ndc_label_name": "Magnesium Citrate SOLUTION 1.745 GM/30ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00363069338",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917010655",
      "ndc_label_name": "Magnesium Citrate SOLUTION 1.745 GM/30ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00363013338",
      "ndc_label_name": "Magnesium Citrate SOLUTION 1.745 GM/30ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015461",
      "ndc_label_name": "Magnesium Citrate SOLUTION 1.745 GM/30ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904741844",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015470",
      "ndc_label_name": "Magnesium Citrate SOLUTION 1.745 GM/30ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917000576",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800062610",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904678744",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896026610",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917020160",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "41250066738",
      "ndc_label_name": "Magnesium Citrate SOLUTION 1.745 GM/30ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917020159",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000066101",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917010657",
      "ndc_label_name": "Magnesium Citrate SOLUTION 1.745 GM/30ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000057601",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917000578",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000042401",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800070938",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000065901",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800032910",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000057501",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "82568005101",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000066001",
      "ndc_label_name": "Magnesium Citrate Solution 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "75450006454",
      "ndc_label_name": "Magnesium Citrate SOLUTION 1.745 GM/30ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487001753",
      "ndc_label_name": "Magnesium Gluconate Tablet 27.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487001751",
      "ndc_label_name": "Magnesium Gluconate Tablet 27.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40093010209",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Capsule 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055862",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013913",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604004078",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007445",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "07610028320",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40093010579",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312005830",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604001269",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917018874",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40093010258",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055738",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904531118",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864078510",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864078599",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536352141",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10006070028",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "35046000324",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135058362",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896063412",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10006073038",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60258017101",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57963010212",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292056512",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51991008136",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864000029",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53217005360",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629413601",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090334600",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69543021712",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629413603",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63739035410",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71800001301",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629413602",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63739035401",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69618002302",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090479200",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63739005802",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333050125",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "85633004030",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "85633004036",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333050120",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "85633004000",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "85633004012",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53217005302",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295013573",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "85633004005",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69367027102",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295012854",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904423960",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845016011",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768030173",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312005535",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40093010328",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312053086",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292056362",
      "ndc_label_name": "Magnesium Oxide -Mg Supplement Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604003107",
      "ndc_label_name": "Magnesium Oxide Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295013566",
      "ndc_label_name": "Magnesium Oxide Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985022713",
      "ndc_label_name": "Magnesium Oxide TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71335059601",
      "ndc_label_name": "Magnesium Oxide Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54569677800",
      "ndc_label_name": "Magnesium Oxide Tablet 400 (240 Mg) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00603021321",
      "ndc_label_name": "Magnesium Oxide Tablet 420 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54738097401",
      "ndc_label_name": "Magnesium Oxide Tablet 420 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917003971",
      "ndc_label_name": "Magnesium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96121000251",
      "ndc_label_name": "Magnesium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917005893",
      "ndc_label_name": "Magnesium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604001718",
      "ndc_label_name": "Magnesium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007441",
      "ndc_label_name": "Magnesium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131007179",
      "ndc_label_name": "Magnesium TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917017677",
      "ndc_label_name": "Magnesium TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00378006001",
      "ndc_label_name": "Maprotiline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378008701",
      "ndc_label_name": "Maprotiline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378009201",
      "ndc_label_name": "Maprotiline HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73141002402",
      "ndc_label_name": "Maraviroc Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710193006",
      "ndc_label_name": "Maraviroc Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722057960",
      "ndc_label_name": "Maraviroc Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023160",
      "ndc_label_name": "Maraviroc Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72319002402",
      "ndc_label_name": "Maraviroc Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72319002502",
      "ndc_label_name": "Maraviroc Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710193106",
      "ndc_label_name": "Maraviroc Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722058060",
      "ndc_label_name": "Maraviroc Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73141002502",
      "ndc_label_name": "Maraviroc Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023260",
      "ndc_label_name": "Maraviroc Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54482005401",
      "ndc_label_name": "Matulane Capsule 50 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440773506",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904737561",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773504",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689013801",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440773540",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022590",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268052215",
      "ndc_label_name": "Meclizine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571066001",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773512",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16103038611",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536129701",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999008700",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536129710",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "62559084110",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700091930",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999008730",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651661",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571066050",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571075101",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60687077501",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16103038608",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65162044110",
      "ndc_label_name": "Meclizine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687077511",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348013910",
      "ndc_label_name": "Meclizine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268052211",
      "ndc_label_name": "Meclizine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022500",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999008715",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69618002701",
      "ndc_label_name": "Meclizine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959022507",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335187205",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008002230",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54738001203",
      "ndc_label_name": "Meclizine HCl TABLET 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52536012901",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022560",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959099530",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205076290",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959022512",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651080701",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030130",
      "ndc_label_name": "Meclizine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746012206",
      "ndc_label_name": "Meclizine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022530",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135095290",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162044111",
      "ndc_label_name": "Meclizine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189030230",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022520",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710116100",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084049011",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559084101",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746044101",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189030260",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863301",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629243201",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022521",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001052800",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788863303",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064790",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746044110",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746012210",
      "ndc_label_name": "Meclizine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54738001201",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68084049001",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237033301",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70710116101",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687077565",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205041610",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919088630",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205041690",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335187201",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064710",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335187203",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162169000",
      "ndc_label_name": "Meclizine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904737661",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291060910",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440173608",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773630",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773620",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773610",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773608",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773604",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689013901",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "42291060990",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773606",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571075201",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "24689014601",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440773621",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090010600",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773615",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002920",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090572801",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773612",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063089915",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063089910",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773690",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090010601",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651761",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090010608",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407062910",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773691",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090010702",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063089930",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571066101",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090457708",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571066110",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090457700",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003300",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356091430",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090572702",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090572804",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090572808",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090741602",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090010604",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268052315",
      "ndc_label_name": "Meclizine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032730",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090457701",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090572800",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268052311",
      "ndc_label_name": "Meclizine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090741708",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003304",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090457704",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436398801",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700080030",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536013301",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090741700",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436001401",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436001403",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003321",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090741704",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959032720",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746012110",
      "ndc_label_name": "Meclizine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003310",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090741701",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003330",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003360",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003390",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003320",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651080899",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073011",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746044210",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559084210",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073001",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57963010101",
      "ndc_label_name": "Meclizine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53746044201",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959003325",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760008730",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760084230",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700091230",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710116200",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760066130",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073065",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760066190",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57629060010",
      "ndc_label_name": "Meclizine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69677015330",
      "ndc_label_name": "Meclizine HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014690",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099620",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205078610",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099610",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760008790",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014610",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651080801",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004860",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135095390",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099630",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205078630",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084049111",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760044430",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014620",
      "ndc_label_name": "Meclizine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746012106",
      "ndc_label_name": "Meclizine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420013020",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559084201",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267013920",
      "ndc_label_name": "Meclizine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004830",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335182502",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162044210",
      "ndc_label_name": "Meclizine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710116201",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014630",
      "ndc_label_name": "Meclizine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420013030",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189023790",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677015315",
      "ndc_label_name": "Meclizine HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049402",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004890",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162044211",
      "ndc_label_name": "Meclizine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934023830",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919075230",
      "ndc_label_name": "Meclizine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189023730",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049403",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205078620",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084049101",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049401",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677015320",
      "ndc_label_name": "Meclizine HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518130801",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205037430",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518381501",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335182508",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934013830",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420013010",
      "ndc_label_name": "Meclizine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090561900",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714002825",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714002801",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00703680101",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00548540000",
      "ndc_label_name": "MedroxyPROGESTERone Acetate SUSPENSION 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629874401",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756009045",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00548540025",
      "ndc_label_name": "MedroxyPROGESTERone Acetate SUSPENSION 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993037083",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714098101",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756009040",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00703680104",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00548541000",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67457088700",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67457088701",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00548541025",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67457088799",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714098102",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090088300",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700031522",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090425100",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70121146702",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762453701",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55150032901",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219146701",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55150032925",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700031525",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70121146705",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993037025",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762453702",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700031527",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205011801",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70121148001",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00548570100",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762453802",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00548571100",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714099901",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090332800",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50102059140",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090592500",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55150033001",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090574700",
      "ndc_label_name": "medroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756009140",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993037179",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555077902",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356036414",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999009205",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063043805",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063043810",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348080510",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090016602",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555077904",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063043890",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687010521",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348080514",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959094310",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999009210",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762005601",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348080505",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289016040",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090016600",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187038230",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289016010",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762005602",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289016007",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687010511",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289016005",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187038220",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289016013",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629882401",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289016050",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629261201",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788989901",
      "ndc_label_name": "medroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788989903",
      "ndc_label_name": "medroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289016030",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187038210",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629261202",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629261207",
      "ndc_label_name": "medroxyPROGESTERone Acetate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762005501",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773730",
      "ndc_label_name": "medroxyPROGESTERone Acetate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629261301",
      "ndc_label_name": "medroxyPROGESTERone Acetate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555087202",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762005502",
      "ndc_label_name": "medroxyPROGESTERone Acetate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773790",
      "ndc_label_name": "medroxyPROGESTERone Acetate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555087204",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289081630",
      "ndc_label_name": "medroxyPROGESTERone Acetate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629261302",
      "ndc_label_name": "medroxyPROGESTERone Acetate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267014130",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090049002",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629882501",
      "ndc_label_name": "medroxyPROGESTERone Acetate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629261303",
      "ndc_label_name": "medroxyPROGESTERone Acetate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004330",
      "ndc_label_name": "medroxyPROGESTERone Acetate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555087302",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348070414",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555087304",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348070430",
      "ndc_label_name": "MedroxyPROGESTERone Acetate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289090842",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289090830",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999049410",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811203",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629882601",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762005801",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762005802",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090049101",
      "ndc_label_name": "MedroxyPROGESTERone Acetate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555017178",
      "ndc_label_name": "Mefloquine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135097325",
      "ndc_label_name": "Mefloquine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090239602",
      "ndc_label_name": "Mefloquine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555017188",
      "ndc_label_name": "Mefloquine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054002511",
      "ndc_label_name": "Mefloquine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090239600",
      "ndc_label_name": "Mefloquine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080325",
      "ndc_label_name": "Mefloquine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739054973",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904757718",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884090761",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904757772",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383085911",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407091048",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856090702",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432012616",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016001",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884090738",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094006362",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383085924",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432012608",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739054972",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856090703",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094006361",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954089620",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871402",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407091024",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033015052",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033015020",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016002",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033015043",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094006359",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033015044",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954089610",
      "ndc_label_name": "Megestrol Acetate Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774920",
      "ndc_label_name": "Megestrol Acetate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380015801",
      "ndc_label_name": "Megestrol Acetate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774910",
      "ndc_label_name": "Megestrol Acetate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555060602",
      "ndc_label_name": "Megestrol Acetate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774930",
      "ndc_label_name": "Megestrol Acetate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774960",
      "ndc_label_name": "Megestrol Acetate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884028901",
      "ndc_label_name": "Megestrol Acetate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884029004",
      "ndc_label_name": "Megestrol Acetate Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555060702",
      "ndc_label_name": "Megestrol Acetate TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904357161",
      "ndc_label_name": "Megestrol Acetate Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429043301",
      "ndc_label_name": "Megestrol Acetate Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629222001",
      "ndc_label_name": "Megestrol Acetate Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884029001",
      "ndc_label_name": "Megestrol Acetate Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904723661",
      "ndc_label_name": "Megestrol Acetate Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380015902",
      "ndc_label_name": "Megestrol Acetate Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380015903",
      "ndc_label_name": "Megestrol Acetate Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429043305",
      "ndc_label_name": "Megestrol Acetate Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380015901",
      "ndc_label_name": "Megestrol Acetate Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884029005",
      "ndc_label_name": "Megestrol Acetate Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629221901",
      "ndc_label_name": "Megestrol Acetate Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50078095513",
      "ndc_label_name": "Melatonin Capsule 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53191022701",
      "ndc_label_name": "Melatonin Capsule 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "74312015745",
      "ndc_label_name": "Melatonin CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "53191021401",
      "ndc_label_name": "Melatonin CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50078095514",
      "ndc_label_name": "Melatonin Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40985028028",
      "ndc_label_name": "Melatonin ER Tablet Extended Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295014149",
      "ndc_label_name": "Melatonin Liquid 1 MG/4ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47469000457",
      "ndc_label_name": "Melatonin Liquid 1 MG/4ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47469007402",
      "ndc_label_name": "Melatonin Liquid 1 MG/4ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917017180",
      "ndc_label_name": "Melatonin TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896088406",
      "ndc_label_name": "Melatonin TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056329",
      "ndc_label_name": "Melatonin TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896088409",
      "ndc_label_name": "Melatonin TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40093010609",
      "ndc_label_name": "Melatonin TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "78742045610",
      "ndc_label_name": "Melatonin TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "74312002832",
      "ndc_label_name": "Melatonin TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94604010075",
      "ndc_label_name": "Melatonin TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "35046000391",
      "ndc_label_name": "Melatonin Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896088418",
      "ndc_label_name": "Melatonin TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80681004100",
      "ndc_label_name": "Melatonin Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "07610022640",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "05388062808",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917013961",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16571087201",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30768048680",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917007508",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30768004005",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "20555003600",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917018855",
      "ndc_label_name": "Melatonin TABLET 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917005642",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "31604004080",
      "ndc_label_name": "Melatonin TABLET 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40985022721",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "31604002741",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "20555003601",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40985021240",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056366",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30768048678",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50035061501",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "35046000390",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896086420",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "31604002742",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54629060900",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268052411",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71610072570",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "77333051625",
      "ndc_label_name": "Melatonin TABLET 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094011061",
      "ndc_label_name": "Melatonin TABLET 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056298",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80681008600",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47469005105",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "77333051610",
      "ndc_label_name": "Melatonin TABLET 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094008659",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131031250",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80681008500",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94604010078",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47469000511",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268052415",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094011059",
      "ndc_label_name": "Melatonin TABLET 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295012827",
      "ndc_label_name": "Melatonin TABLET 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54458021360",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51991001406",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71610072580",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094008661",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896086406",
      "ndc_label_name": "Melatonin TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80681014800",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295013723",
      "ndc_label_name": "Melatonin Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30768003560",
      "ndc_label_name": "Melatonin Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30768000541",
      "ndc_label_name": "Melatonin Tablet 300 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "07610015540",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "05388062809",
      "ndc_label_name": "Melatonin TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00761015540",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "31604002743",
      "ndc_label_name": "Melatonin TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16571087301",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917020311",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896083409",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "77333052025",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "35046000393",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "20555003900",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50035061503",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80681004000",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "20555003901",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295013572",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "77333052010",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896083403",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80681004001",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30768015745",
      "ndc_label_name": "Melatonin TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056414",
      "ndc_label_name": "Melatonin TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80681004002",
      "ndc_label_name": "Melatonin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94604010079",
      "ndc_label_name": "Melatonin TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40093010305",
      "ndc_label_name": "Melatonin Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268055211",
      "ndc_label_name": "Melatonin Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917014057",
      "ndc_label_name": "Melatonin TABLET DISPERSIBLE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40093010164",
      "ndc_label_name": "Melatonin TABLET DISPERSIBLE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268055215",
      "ndc_label_name": "Melatonin Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47469005865",
      "ndc_label_name": "Melatonin TABLET DISPERSIBLE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917017248",
      "ndc_label_name": "Melatonin TABLET DISPERSIBLE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "47469000458",
      "ndc_label_name": "Melatonin TR with Vitamin B6 Tablet Extended Release 3-10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11845011135",
      "ndc_label_name": "Melatonin/Vitamin B-6 Ex St TABLET 3-1 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440584090",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440684090",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440684000",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584030",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584001",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584000",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584081",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440684014",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440684030",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300012510",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039607",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584085",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440684001",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440684085",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440784090",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440684081",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300012501",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039690",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667200",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788004701",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039660",
      "ndc_label_name": "Meloxicam TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440784030",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788004705",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090533900",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039630",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353051360",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436112502",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077701",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040114",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788004710",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077750",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090533903",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059330",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353097960",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436978702",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039615",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040128",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077710",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040160",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667104",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059360",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098601",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407061110",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353097930",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040130",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039695",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999086990",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407061190",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098602",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667106",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085720",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999086960",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090533901",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040115",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667107",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085740",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098604",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436112501",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760065330",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098600",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090533904",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040190",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407061101",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442012701",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098607",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085730",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760065360",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090533907",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090534000",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353003830",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085715",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046990",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090533906",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085760",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008310",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436978701",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667102",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353003860",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687019901",
      "ndc_label_name": "Meloxicam TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135071618",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268052611",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046907",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862009805",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760041960",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667103",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999086930",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687019911",
      "ndc_label_name": "Meloxicam TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008315",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760041907",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046960",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005101",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008390",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655057752",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098603",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760041990",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629201901",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760041930",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62250067630",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69336010230",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629332802",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085721",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098606",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760065390",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629332801",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046910",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880101",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092460",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071052930",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458096416",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090533902",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442012710",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180050201",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046930",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518020001",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019030",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880103",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880102",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667100",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046915",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880109",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862009801",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092428",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065730",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880108",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788941801",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667101",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046935",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015907",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071052960",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054230",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087253",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092407",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788941803",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268052615",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135071690",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015915",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005105",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865033390",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509115906",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092415",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015912",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655057726",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008330",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003030",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790409",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282015301",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629332803",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092430",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69336010260",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085714",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180050203",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092455",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880104",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82461071230",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790401",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335188803",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518020003",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111023401",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880106",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092472",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934001130",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509112506",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880107",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335232703",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335188802",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760065307",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788941806",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092490",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003090",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509112509",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092400",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058030",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335232709",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008360",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092411",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335188801",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335232700",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509115903",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092414",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040395",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019060",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629332810",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335195602",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335195601",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335232707",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509115909",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040330",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003930",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054260",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790403",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789044714",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335195603",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058060",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790406",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004402",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008301",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065760",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880100",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008303",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054453",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087230",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788941809",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509105103",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008302",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865033301",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335232701",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509105109",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162173800",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040360",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335232702",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004501",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009013005",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865013810",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335232704",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804002930",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040307",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282015310",
      "ndc_label_name": "Meloxicam TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054430",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003910",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804002960",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003990",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054460",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004403",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865013801",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087260",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509112503",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040390",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865013890",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789044715",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865033310",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003907",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420003960",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004401",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004502",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509105106",
      "ndc_label_name": "Meloxicam Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584160",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584190",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584100",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077601",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440684185",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584130",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584185",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584101",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440684101",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440784190",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584181",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356080860",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090680303",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440684160",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440684100",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440684191",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440684190",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039514",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584191",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039530",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268052515",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356080890",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440684130",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788004610",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077610",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090586100",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440684181",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098502",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407061001",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039595",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527141901",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300012410",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300012401",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085620",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788004601",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090787500",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085614",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090586102",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527141910",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039590",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356080830",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085630",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571077650",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407061010",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760044810",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090586103",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788004605",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353012730",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039520",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085690",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063039560",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655073152",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442012601",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436009802",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062960",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062930",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353012760",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53225307501",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090586104",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289027220",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629324802",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407061090",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098500",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999086810",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098501",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53225307503",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090680301",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043420",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862009705",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085601",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098503",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090586101",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098504",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53225307506",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090680304",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043490",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071052840",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53225307507",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436009801",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090680302",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268052511",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458096516",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090683200",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135071590",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071052860",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289027290",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085615",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090749500",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085645",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289027260",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436112402",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629324810",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788170103",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760040407",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085621",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436112401",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53225307505",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043415",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53225307502",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071052856",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788170108",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760040410",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289027230",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436112403",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289027214",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008214",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53225307504",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788170101",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092315",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043407",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760040430",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085660",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760044890",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071052807",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760044807",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788170104",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092372",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135071518",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760044830",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111023301",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043414",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071052890",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760044860",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788170106",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018930",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629202001",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442012610",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760040460",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005001",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005005",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043460",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772603",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038030",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071052815",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043410",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760040490",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875806",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772606",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008220",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875800",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051660",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071052820",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071052830",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043430",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015812",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772609",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008230",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875801",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040230",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788170109",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875802",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043472",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69336010130",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518003100",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008260",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875803",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040290",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772600",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934001030",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008290",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518302301",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518129900",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862009701",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092330",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865013710",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772602",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934029790",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180050101",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335040600",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518302300",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180050103",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335040601",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865013790",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875808",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092307",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772601",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038060",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934001090",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772608",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058360",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865033201",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875809",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335040602",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015807",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058380",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934029730",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092300",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865013701",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004330",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69336010160",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058315",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015815",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004315",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092328",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092311",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004202",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004390",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518302302",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004360",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518003904",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004203",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058370",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335208002",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055802",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004103",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092314",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004201",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092355",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009012905",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088130",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058330",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055803",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056304",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092390",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055804",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205092360",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509112406",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865033290",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058345",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055902",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056301",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335040604",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040260",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335208001",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509112409",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282015201",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789044614",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056303",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282015210",
      "ndc_label_name": "Meloxicam TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004303",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004301",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335208004",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055801",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018960",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055901",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058353",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055903",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040295",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055904",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865033210",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425056302",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004101",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004102",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004302",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509112403",
      "ndc_label_name": "Meloxicam Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781020050",
      "ndc_label_name": "Melphalan Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135094337",
      "ndc_label_name": "Memantine HCl Solution 2 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505616205",
      "ndc_label_name": "Memantine HCl Solution 2 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13925054012",
      "ndc_label_name": "Memantine HCl Solution 2 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668057309",
      "ndc_label_name": "Memantine HCl Solution 2 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527194313",
      "ndc_label_name": "Memantine HCl Solution 2 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342006628",
      "ndc_label_name": "Memantine HCl Solution 2 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335032213",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527122206",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300017216",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904650661",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527122205",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832111360",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241007105",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591387544",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090443402",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241007106",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746016960",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722080860",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591387560",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904650606",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335032286",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591387545",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090640001",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090420300",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629251101",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342029809",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300017205",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353017018",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090443400",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342029815",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603011902",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268058813",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862065399",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016518",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268058811",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090443401",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090583200",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353016553",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407028560",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111059760",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180023007",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090583201",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332007671",
      "ndc_label_name": "Memantine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090640002",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111059705",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090583202",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679012202",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162016906",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332007660",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135089660",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788773009",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090735601",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629251201",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090640000",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788864706",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862065360",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788773003",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332007631",
      "ndc_label_name": "Memantine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610001118",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687018411",
      "ndc_label_name": "Memantine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610088580",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090735602",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578000405",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788716503",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162200405",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332007642",
      "ndc_label_name": "Memantine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788716509",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687018457",
      "ndc_label_name": "Memantine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162200406",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788716506",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335190801",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442019305",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335190802",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788773006",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603011901",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679012203",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606051502",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788864703",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335189902",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788864709",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578000414",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189053860",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606051504",
      "ndc_label_name": "Memantine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591390087",
      "ndc_label_name": "Memantine HCl Tablet 28 x 5 MG & 21 x 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904650561",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527122106",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335032186",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832111260",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591387044",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591387060",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904650506",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722080760",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342029709",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591387045",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090734801",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241007006",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300017105",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090592601",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335173202",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090592600",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111059660",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687017357",
      "ndc_label_name": "Memantine HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407028460",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "29300017116",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610091160",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090629101",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610091170",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162200305",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629733301",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332007531",
      "ndc_label_name": "Memantine HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53746017360",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342029715",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603011801",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090734800",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61442019205",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578000314",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332007591",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332007560",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629251301",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090629100",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679012103",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268058713",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606051404",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268058711",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64679012102",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687017311",
      "ndc_label_name": "Memantine HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135089560",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629251401",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162017306",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610097980",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862065260",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189029430",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180022907",
      "ndc_label_name": "Memantine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72606051402",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610091180",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162200306",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578000305",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189029490",
      "ndc_label_name": "Memantine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69076091302",
      "ndc_label_name": "Mercaptopurine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054458127",
      "ndc_label_name": "Mercaptopurine TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054458111",
      "ndc_label_name": "Mercaptopurine TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69076091325",
      "ndc_label_name": "Mercaptopurine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407098325",
      "ndc_label_name": "Mercaptopurine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378354725",
      "ndc_label_name": "Mercaptopurine Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378354752",
      "ndc_label_name": "Mercaptopurine TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093922489",
      "ndc_label_name": "Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70748021416",
      "ndc_label_name": "Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268057711",
      "ndc_label_name": "Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687065033",
      "ndc_label_name": "Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378137578",
      "ndc_label_name": "Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651039708",
      "ndc_label_name": "Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832605612",
      "ndc_label_name": "Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382045219",
      "ndc_label_name": "Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268057715",
      "ndc_label_name": "Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332072435",
      "ndc_label_name": "Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629882701",
      "ndc_label_name": "Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877071712",
      "ndc_label_name": "Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407097612",
      "ndc_label_name": "Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687065032",
      "ndc_label_name": "Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682011320",
      "ndc_label_name": "Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "37000074087",
      "ndc_label_name": "Metamucil 4 in 1 Fiber Packet 25 % Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37000025445",
      "ndc_label_name": "Metamucil 4 in 1 Fiber Packet 51.7 % Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37000002404",
      "ndc_label_name": "Metamucil 4 in 1 Fiber Packet 51.7 % Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37000002404",
      "ndc_label_name": "Metamucil MultiHealth Fiber Packet 58.12 % Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37000074087",
      "ndc_label_name": "Metamucil Packet 28 % Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37000074091",
      "ndc_label_name": "Metamucil WAFER ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37000074092",
      "ndc_label_name": "Metamucil WAFER ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440573890",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385097705",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440573892",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082333",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082330",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440573881",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440573801",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440573805",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082332",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224000750",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082305",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291082510",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291049718",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082362",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774890",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291049701",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082360",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224000760",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342023911",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062309",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385097701",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082390",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291049705",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291082536",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300038901",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756014202",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291049790",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090539600",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385097711",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033005501",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291049710",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806063205",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291049736",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877041305",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291082530",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090651501",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058594",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300038905",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806063201",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062310",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291049750",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788720403",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291082560",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090651504",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062301",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291082512",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090539604",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090149400",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291082590",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849501",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090149403",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700073490",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090651600",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291082518",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757601",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090371902",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090149402",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788890306",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090539700",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687064011",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757603",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385097790",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757602",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090371903",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090371900",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002060",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757700",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919045030",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757604",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062350",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919045090",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090711600",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090539601",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044753",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881401",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877015905",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090791800",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090149401",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629288301",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757600",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090539602",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044770",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788890303",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645059559",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756014201",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090149404",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862029101",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919092260",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090651500",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044794",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010049110",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693209",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077960",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090371901",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877041301",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077990",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090651503",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045460",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030494",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788720406",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094090460",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090539603",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877041390",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788720408",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757900",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045492",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044780",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881403",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788720401",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090651502",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788720409",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849506",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268055015",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055492",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045794",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881406",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849508",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268055011",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886601",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849509",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077930",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057894",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057860",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881409",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788890309",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655055082",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934078860",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886608",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629288302",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058760",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058670",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788890301",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010049105",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505026001",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205068630",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788890308",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877015901",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058794",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058694",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315041001",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934013430",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687064001",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335072004",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315041005",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693203",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083730",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058770",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934013498",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934078830",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919076960",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045730",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010049101",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693206",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000960",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058792",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205037230",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205018660",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629288303",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045770",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335072002",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693208",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010595",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065260",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002080",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205018690",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629914601",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053330",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002094",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010049109",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040060",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085894",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044760",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205068660",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094090450",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058660",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610030480",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044730",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040093",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242401",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045430",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205068672",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693201",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061370",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045494",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045753",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789045490",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242402",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045792",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205068690",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849503",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083760",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045780",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045760",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789045493",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242407",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053353",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335072001",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881408",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085860",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055453",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053370",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014760",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000990",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055494",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045470",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886603",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242405",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058680",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053380",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014790",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000993",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058730",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055430",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886606",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005998",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061380",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061360",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886609",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010593",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065294",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057870",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934078890",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009011710",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083780",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065253",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205018630",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834050005",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242400",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058780",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335072006",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009018005",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083794",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083753",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045453",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804019560",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000930",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061330",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045480",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085853",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085880",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061353",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053360",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242404",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005960",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061394",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055460",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242409",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005930",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065230",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055470",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010590",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010582",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085830",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055480",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014778",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010501",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085870",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057880",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189006490",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385012810",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189015090",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065270",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005993",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040082",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010560",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065280",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040086",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014730",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083770",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040090",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189015030",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005990",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040001",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789045460",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789045530",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834050001",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291049890",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291049818",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082405",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082490",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033005601",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300039901",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291082490",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385097801",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090260",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291049850",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090524601",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291082410",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342024011",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268055115",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806063301",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090524602",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090276701",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094080460",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090737201",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062450",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291049801",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066660",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090230",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090683900",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090737203",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780303",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090753400",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877041405",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291082450",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074080",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090753500",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090737200",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655007726",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853201",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224010750",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788720508",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062401",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047282",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862029201",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090737202",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655007752",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044153",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224010760",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780306",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090276700",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789054893",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877041401",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268055111",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629914701",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086780",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788720501",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780309",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090524600",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009011801",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789009730",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780308",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010682",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162129301",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788720503",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822501",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090524603",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789009760",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009018101",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010049201",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010693",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934008330",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788720506",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010049210",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090737300",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086770",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010049205",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074060",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047201",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789045160",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934008390",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385012901",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090753401",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014800",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335077602",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385012950",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756014301",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014830",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066680",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094080450",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788720509",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780301",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934011730",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335077603",
      "ndc_label_name": "MetFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066653",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610074053",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086753",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086760",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578003601",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010601",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010690",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789045130",
      "ndc_label_name": "metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440574601",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440574685",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440574681",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155010401",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378718705",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904716461",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440574600",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440674681",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155010405",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155010409",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440674605",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155010406",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440574605",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084310",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440574690",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774690",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084305",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155010410",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440674692",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094911",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440674685",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385090210",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440574692",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063088960",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034945",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054490",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135061905",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063088990",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774692",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094901",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084301",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353012845",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353051480",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034953",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806031505",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353012830",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094905",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063088921",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356088630",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034980",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353088553",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034973",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054430",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353012860",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054460",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063088993",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063088930",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685605",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353088573",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034986",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054493",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353012880",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353009880",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353011480",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063088998",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090775000",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062001",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353051473",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063054498",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353012886",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353088580",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353012873",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353012853",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090787700",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062010",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353088545",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034930",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353093630",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353088586",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353051453",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353051445",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090787704",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090077500",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353093686",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034960",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353093645",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353093673",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353051486",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098780",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090787800",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217700",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098730",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353051430",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098731",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357902",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098787",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098786",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228010701",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217705",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062050",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353051460",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098743",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357905",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090077502",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098796",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224022070",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685602",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062081",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353088560",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098753",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685604",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090077505",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090077503",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919039790",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090745403",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217704",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098745",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098773",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090758800",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217702",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357904",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001046",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090758604",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090650700",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098760",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090505200",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090787705",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357900",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090489200",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382076010",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224022050",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090650800",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217703",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090745404",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700066990",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357903",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090650704",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645054559",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655056352",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685700",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090369105",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090745405",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664047488",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090369102",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685603",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808301",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086030",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090745500",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228010730",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090758602",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651085601",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090650702",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090745402",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843007",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002144500",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090758600",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651085605",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090758605",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011360",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090650703",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757800",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856003",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664047458",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700066930",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919039730",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090758700",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919039760",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090650705",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090758603",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856006",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011305",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664047451",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629850301",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090786600",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135068418",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685600",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090787703",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856008",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135068405",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011318",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001005",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090786800",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135068490",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090745400",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228010705",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860001",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187023930",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011390",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001099",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002144506",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629139703",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090787702",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011301",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038310",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629139704",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687016201",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877056301",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664047453",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001001",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228010710",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760049760",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006509",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788901",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760049790",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877056310",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651085699",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877093205",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224022060",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760097560",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013405",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788906",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629850401",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094048070",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687016211",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788907",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086002",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919039782",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088464",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856001",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877093210",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382076005",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877056305",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843003",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086060",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187023978",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008504",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367018205",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382076001",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788903",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645058459",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843008",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959086090",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629139705",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008507",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006599",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843006",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788908",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843009",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860006",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002144503",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001090",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183305",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934042760",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788912203",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788909",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367018201",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006505",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760097590",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808308",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183308",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088455",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788912206",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006501",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038301",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934020730",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629139701",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860007",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335229101",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335128902",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934013560",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013404",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006510",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934042730",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629139702",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860008",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335253305",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183301",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934042790",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205055590",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934013530",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205054800",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094048060",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205055530",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067360",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021080",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205054830",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088411",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934020760",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205055560",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645030059",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008502",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71709011206",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021260",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205055578",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088472",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088478",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088430",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808303",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335128908",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018930",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067270",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088400",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088490",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335128905",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008503",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808306",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067380",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018998",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093780",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088460",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183300",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067230",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008505",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808309",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71717010611",
      "ndc_label_name": "MetFORMIN HCl TABLET 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067253",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094160",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008508",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183303",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067280",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183304",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843001",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183306",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094180",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022090",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335128903",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021280",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043501",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183307",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856009",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162152301",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043504",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018993",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335128906",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022030",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301001002",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71709011207",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860003",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022060",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335183302",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301001001",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860009",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018921",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021253",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018942",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367018210",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043503",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093760",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009004710",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038305",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162152305",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934083090",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022082",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008501",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189063582",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008506",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043502",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335128901",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067260",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018960",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018990",
      "ndc_label_name": "MetFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009017510",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301001003",
      "ndc_label_name": "metFORMIN HCl Tablet 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440673900",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440573981",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440673981",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440573985",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378718505",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440573900",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440673992",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440573992",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440673985",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440673901",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440673990",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440673905",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440573901",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440573905",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385090410",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904716261",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155010209",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356069160",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155010210",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084101",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773994",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440573990",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094701",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155010205",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084105",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063052790",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806031305",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094711",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063052730",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773914",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806021305",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155010206",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034053",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063052793",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034030",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063052714",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063052798",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773960",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063052720",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084110",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058970",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063089830",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034080",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063052760",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063089893",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773990",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034096",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658079001",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084230",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063089890",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058960",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063052794",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063089898",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773992",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058930",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094705",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208104",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034060",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058980",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058953",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353089430",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440773995",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084280",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806021310",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685804",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034092",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058992",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058994",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098253",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135061710",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098280",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063089820",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685805",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034094",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084253",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084296",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208106",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155010201",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999010628",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098260",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759506",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090076905",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084270",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098292",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090354300",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063089860",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306403",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098270",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228010501",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090279600",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062201",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062250",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727805",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034070",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306404",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098296",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002125103",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228010505",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090076900",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090076904",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759504",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034075",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306406",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062210",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700066600",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959020700",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685800",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306405",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759700",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058975",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685900",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208100",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651085401",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651085405",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685803",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727803",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228010510",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058996",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224002060",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208103",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011118",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011101",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727800",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727806",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959020728",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084260",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959020730",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306400",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687015501",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011160",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090728000",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759500",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700066660",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084292",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959020760",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090685806",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135068005",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760097360",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759505",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759503",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700073690",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084294",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700066690",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090701300",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135068018",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629139503",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228010530",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011112",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664039758",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098230",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011145",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224002050",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000899",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629850101",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224002070",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011136",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760052360",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098294",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187023878",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700066630",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094068860",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267049393",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664039753",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011190",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382075805",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062281",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629850201",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919031360",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786709",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877056105",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687015511",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000801",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407607",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208105",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267049314",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919031390",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811001",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877093005",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629139502",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877056101",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407608",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090489100",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877056110",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000805",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811006",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811007",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000890",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645054459",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786706",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648500",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877093001",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006305",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006309",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367018001",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811008",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407603",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786707",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727804",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094068870",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934021260",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934013660",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205056260",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865203",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407609",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849803",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002125100",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382075801",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934040430",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934040460",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335222403",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865206",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786703",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849806",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002125106",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382075810",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934040490",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013204",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335222408",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788912103",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849801",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849809",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664039751",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407606",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205062230",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088255",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091760",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038110",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849807",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856401",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651085499",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811003",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088211",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335222401",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189065882",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013205",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865201",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865208",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011110",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865209",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088230",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335222404",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019290",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335222409",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865207",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788912106",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011127",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367018005",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088278",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027880",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135068090",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046780",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038101",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038105",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629139501",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367018010",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335222400",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092053",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645058259",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091730",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006310",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934021290",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407601",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006301",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091794",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092953",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786701",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092060",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934006660",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934042290",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786708",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205078478",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061730",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205078430",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811009",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71717010411",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934021230",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088260",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849808",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088264",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061782",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088290",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934013630",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162152201",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934078460",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335222406",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013206",
      "ndc_label_name": "MetFORMIN HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335222402",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019293",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046760",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205078490",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000803",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205056290",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091780",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088200",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335222407",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000802",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092960",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088272",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091770",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335222405",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092970",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027860",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092994",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092080",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092980",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091753",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189065830",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092930",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019221",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71709011006",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019220",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162152205",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019230",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71709011007",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789053142",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019260",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009017410",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189021990",
      "ndc_label_name": "MetFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009004610",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000801",
      "ndc_label_name": "metFORMIN HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440574501",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008296",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440574500",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440674592",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378718605",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440674585",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440674505",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440574585",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440574590",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034453",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440574505",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774590",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440574592",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155010301",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440674590",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155010306",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155010310",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999049530",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440574581",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774592",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440674501",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084201",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155010309",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084210",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094801",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305000",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440674581",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904716361",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155084205",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008292",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094811",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008253",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305004",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090710602",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700073090",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135061805",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806031401",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034460",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008280",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062110",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224012050",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090710605",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011290",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155010305",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008230",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353053060",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081192",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062150",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959089660",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224012060",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000901",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094805",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034480",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261202",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999049560",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675300",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092490",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002142200",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094058060",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008260",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081153",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305005",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305002",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651085501",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919099082",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011205",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382075901",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034492",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081160",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675302",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675305",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000905",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877021805",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877021810",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006405",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353053080",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062101",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228010601",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675400",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875609",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094058070",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877093101",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088355",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081180",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261200",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228010630",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090710604",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205014260",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790109",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645058359",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088390",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483062181",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090710700",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664043551",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002142203",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088364",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860301",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790106",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091892",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675304",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228010605",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760010090",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002142206",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71709011106",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091860",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852803",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71717010510",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090710600",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959089601",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919099090",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664043553",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71709011107",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664043588",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852808",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71717010550",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090746500",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919099060",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382075910",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011201",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022190",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135068330",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852809",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000902",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224012070",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267049730",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790103",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687014311",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000901",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860308",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860309",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83301000903",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664043558",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875603",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875601",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135068390",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651085505",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875606",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367018105",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000990",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011218",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875608",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006410",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877056201",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011227",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006401",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205014230",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877056210",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011260",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088360",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088330",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382075905",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687014301",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092360",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088300",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645054759",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135068318",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092380",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025003",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790101",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877056205",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092392",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025002",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860306",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790108",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367018101",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091880",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038201",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852801",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088372",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040990",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025001",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788852806",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025006",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860303",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092330",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038205",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092353",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367038210",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022160",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006409",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010006499",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013304",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013305",
      "ndc_label_name": "MetFORMIN HCl TABLET 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205056760",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088311",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088378",
      "ndc_label_name": "MetFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025004",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025005",
      "ndc_label_name": "metFORMIN HCl Tablet 850 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054071020",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700088201",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806031801",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406577123",
      "ndc_label_name": "Methadone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054855424",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054071025",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959038630",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054457125",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406577101",
      "ndc_label_name": "Methadone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919067060",
      "ndc_label_name": "Methadone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959038602",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904653061",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629190501",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406577162",
      "ndc_label_name": "Methadone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959038660",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722094701",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356083430",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904741761",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919067090",
      "ndc_label_name": "Methadone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700088230",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629377110",
      "ndc_label_name": "Methadone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107008901",
      "ndc_label_name": "Methadone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629102701",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356083490",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64850060401",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959038690",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689083699",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084073801",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66689082010",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700088260",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877066001",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919067030",
      "ndc_label_name": "Methadone HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877011601",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700088290",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084073811",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335136003",
      "ndc_label_name": "Methadone HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406575523",
      "ndc_label_name": "Methadone HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054070925",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406575501",
      "ndc_label_name": "Methadone HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107008801",
      "ndc_label_name": "Methadone HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054070920",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054457025",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959043502",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054855324",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722094601",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959043530",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335049301",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356083560",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356083530",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999096360",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687021411",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406575562",
      "ndc_label_name": "Methadone HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72865012001",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687021401",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806031701",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959043560",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959043590",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629190601",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64850060301",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877065901",
      "ndc_label_name": "Methadone HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429038101",
      "ndc_label_name": "Methimazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342033611",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185021010",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884064101",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185021001",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832607311",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068011",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687037001",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135020618",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578021301",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268049611",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068001",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155007101",
      "ndc_label_name": "Methimazole TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687037011",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629222401",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804023130",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980026501",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380021301",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135020690",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629202701",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268049615",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162180301",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822701",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629925101",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406301",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980026101",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406303",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335302701",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293082101",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162180302",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452032920",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822703",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603031601",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335290601",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73190003001",
      "ndc_label_name": "methIMAzole Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155007001",
      "ndc_label_name": "Methimazole TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832607211",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884064001",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429038001",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185020501",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268049515",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342033511",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629202601",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884064005",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333400",
      "ndc_label_name": "Methimazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687035711",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135020518",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185020510",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687066901",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822601",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629924901",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687035701",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268049511",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687066911",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980026001",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090236600",
      "ndc_label_name": "Methimazole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629913701",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876801",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162180202",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629222501",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293082001",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135020590",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335302602",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090653600",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629925001",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888301",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603031501",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876803",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380021201",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980026401",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335302601",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788822603",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380021202",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452032820",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162180209",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162180207",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162180205",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335288101",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888303",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335302603",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578021201",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162180201",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73190002901",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162180204",
      "ndc_label_name": "methIMAzole Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440174040",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087920",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774085",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774020",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135072201",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774010",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774028",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774012",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774024",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090328",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774090",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774040",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722053301",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774060",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356088760",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904705761",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090330",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077953",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135066401",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774081",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573041302",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090318",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573041304",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135072205",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094880",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077980",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "15014091010",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356088730",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094892",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090324",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087940",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077992",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094883",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094890",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722053305",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356088790",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040550",
      "ndc_label_name": "Methocarbamol TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077930",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077960",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094870",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090017601",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090017603",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094853",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090320",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090017605",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077970",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077990",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090017604",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090018400",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090018203",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094860",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547040510",
      "ndc_label_name": "Methocarbamol TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090017704",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094830",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090017702",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090018204",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319104",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090018302",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090018300",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319103",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090018205",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090017800",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584705",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319101",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326502",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090018304",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090355703",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326504",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584600",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090018201",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436012303",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326500",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090375600",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090355701",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357004",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584703",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436053302",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090430902",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407046705",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090328100",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090430900",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090355704",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357801",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268052015",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436991003",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090479300",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651034005",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090355705",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584604",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357000",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584602",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407046701",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700089060",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436012301",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059230",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357803",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584704",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357804",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268052011",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959016724",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700089090",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959016700",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059290",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584701",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436012302",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090430904",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959016721",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959016760",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011801",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959016710",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036807",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436053301",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436991001",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590700",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700071620",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099060",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036840",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959016712",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629162206",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436991002",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959016703",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959016715",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700071630",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059260",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061030",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959016720",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898401",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959016790",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959016730",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030440",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055901",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629162201",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561017301",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959016740",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898402",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014760",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030420",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099090",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014730",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629162208",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629112301",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700071690",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639106",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036830",
      "ndc_label_name": "Methocarbamol TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030430",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055911",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267014520",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898403",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629241701",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011805",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882206",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008730",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348010920",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036860",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267014530",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898404",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797306",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061060",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010075401",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008790",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700071660",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036890",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405809",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405806",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882208",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061090",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934011430",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882209",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099030",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629162203",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639101",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639103",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205010390",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561017305",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205009790",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093014004",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651034001",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629241801",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639104",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639108",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335084407",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629162202",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335097007",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205001920",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760048290",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629488201",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882202",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821303",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022330",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629162205",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022360",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016760",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014790",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739099110",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69036091010",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821309",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059970",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267014540",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059960",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335084404",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061040",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267014560",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584061150",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882203",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083280",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882201",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059992",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022370",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629162204",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267014590",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518172306",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888003",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083290",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886703",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028430",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083253",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629162207",
      "ndc_label_name": "Methocarbamol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797303",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093014005",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888006",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028490",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886709",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001218",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083260",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629488202",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797309",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335097004",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888009",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001220",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010075405",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002160",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789042818",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898405",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821306",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059953",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367025501",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048130",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016730",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002190",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420066760",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629928801",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69306050030",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162248701",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70868091010",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049920",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205037530",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002193",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028301",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405801",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584061190",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028472",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022390",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420062601",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205037590",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002199",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028304",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639102",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205010320",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189066530",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059980",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420062660",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335084402",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048193",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425057703",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788639109",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335238302",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048190",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083270",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028305",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022380",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049928",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509191003",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882204",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083292",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095490",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162136305",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425057704",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059930",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023301",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162192901",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886706",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049918",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509191001",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162248705",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425057705",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059990",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420062630",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189028460",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367025505",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385012350",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509191006",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001240",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509291001",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083230",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013801",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789011040",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584061110",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420062690",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028303",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039782",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205037520",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162136301",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095400",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048101",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022353",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420066701",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022392",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048160",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162192905",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001224",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002182",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385012301",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039701",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804012190",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789042830",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027502",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048182",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001230",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023305",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027503",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420066730",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002101",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420066790",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804012130",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027501",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002194",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425057701",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048195",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095460",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013802",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095472",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028302",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509191009",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425057702",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509291003",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095430",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509291006",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095455",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509291009",
      "ndc_label_name": "Methocarbamol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634083690",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135066501",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634083671",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090514",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774106",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774120",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774104",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135072301",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547022610",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353043670",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35561021113",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090520",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774190",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774130",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090560",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722053401",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090017002",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090017007",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573041402",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090530",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774192",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440774140",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353043653",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35561021112",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317300",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319200",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090540",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094960",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135072305",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904705861",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094953",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090017200",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319202",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090416402",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547022650",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094970",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722053405",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353043660",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090017000",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178102",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090355604",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090416404",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090017003",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094980",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573041404",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178101",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178100",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090355600",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090500803",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090416407",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090017006",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090017001",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353043680",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178104",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178103",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090416401",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090500806",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090500801",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319206",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090017004",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178106",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178107",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178204",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090500600",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009903",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090500804",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090339104",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319204",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319201",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090416200",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090178300",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268052115",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002035920",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009900",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090416400",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319207",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436053402",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090500802",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319203",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436053401",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700072040",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009910",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090416403",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090355601",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436053404",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268052111",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090355602",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436053403",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014890",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009920",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436402701",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090355606",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436077002",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009930",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090355603",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436402702",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090360",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700072060",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407046801",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090355607",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009921",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009990",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090358700",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009928",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187013045",
      "ndc_label_name": "Methocarbamol TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011905",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009940",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090416406",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009945",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700021830",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407046805",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700021890",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629112501",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760034730",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009960",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090500504",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009950",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700072030",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002035930",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072590",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629241901",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061660",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429011901",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090500800",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651034101",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700072090",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651034105",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760077060",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70868090190",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090372",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072528",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090500807",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072540",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760034740",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687056811",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035460",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025108",
      "ndc_label_name": "Methocarbamol TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187013040",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760077030",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959009915",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061640",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760077028",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760034728",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061672",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335082806",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780903",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760077090",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002035940",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090390",
      "ndc_label_name": "Methocarbamol TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014860",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061630",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062760",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335279502",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817203",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014830",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700021860",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629242001",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035440",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062790",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001945",
      "ndc_label_name": "Methocarbamol TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002290",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817206",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035430",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687056801",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899503",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061620",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001990",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561017401",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789052182",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887603",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061690",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760034760",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267014630",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001930",
      "ndc_label_name": "Methocarbamol TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187013060",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899501",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385012450",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788937606",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090330",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760034792",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267014690",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187013030",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739099210",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899504",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017102",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093014104",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899502",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760077040",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267014691",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187013090",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267014684",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267014640",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049001",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093014105",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817202",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035490",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780906",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561017405",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798001",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267014660",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095560",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006860",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584061210",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001960",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780909",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629112401",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788937603",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780902",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008000860",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025100",
      "ndc_label_name": "Methocarbamol TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584061250",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267014612",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798008",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267014620",
      "ndc_label_name": "Methocarbamol TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335077106",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780908",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509134106",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025103",
      "ndc_label_name": "Methocarbamol TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010077005",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887606",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817207",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780901",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335082801",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798003",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817209",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025106",
      "ndc_label_name": "Methocarbamol TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006840",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887609",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69036093090",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817208",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335082804",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798006",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367025605",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025109",
      "ndc_label_name": "Methocarbamol TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006890",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788937601",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518309601",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788937602",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335090900",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798009",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006830",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335077101",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025102",
      "ndc_label_name": "Methocarbamol TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006845",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335077102",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788937609",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335090902",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788937608",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335090905",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335090909",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025105",
      "ndc_label_name": "Methocarbamol TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025104",
      "ndc_label_name": "Methocarbamol TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024253",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584061290",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335279501",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367025601",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083353",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335172703",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335077105",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025107",
      "ndc_label_name": "Methocarbamol TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083370",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335082803",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335279503",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010077001",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083392",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335172705",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335090906",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335082802",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002282",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335090903",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335279504",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518173807",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004160",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335172706",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335172701",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335082805",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023401",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335090904",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017453",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006820",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023405",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335279506",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335172702",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335090908",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385012401",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335279500",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72275035190",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205028530",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025890",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017480",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335172704",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335279505",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063860",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059853",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789042960",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205028540",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002001",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162193005",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335230505",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013453",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002103",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083360",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789052160",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205028545",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095500",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004130",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335230506",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024280",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095572",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162248805",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025860",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025101",
      "ndc_label_name": "Methocarbamol TABLET 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509177009",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002003",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013460",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059860",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063801",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039882",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017460",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335077104",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002102",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509134103",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017470",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059870",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049003",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789042920",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024270",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335090901",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008000890",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025810",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162193001",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059880",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509177003",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025830",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002298",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335090907",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004140",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063830",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095555",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083330",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509177006",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063890",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024260",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002101",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002201",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017101",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083380",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049002",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789002293",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095590",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083390",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039801",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162248801",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789042930",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004120",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789052130",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789042940",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017103",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789052120",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002002",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095530",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008000830",
      "ndc_label_name": "Methocarbamol Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027735",
      "ndc_label_name": "Methotrexate Sodium (PF) SOLUTION 1 GM/40ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00703367801",
      "ndc_label_name": "Methotrexate Sodium (PF) SOLUTION 1 GM/40ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61703040841",
      "ndc_label_name": "Methotrexate Sodium (PF) Solution 1 GM/40ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00703367881",
      "ndc_label_name": "Methotrexate Sodium (PF) Solution 1 GM/40ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61703040825",
      "ndc_label_name": "Methotrexate Sodium (PF) Solution 1 GM/40ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323012110",
      "ndc_label_name": "Methotrexate Sodium (PF) SOLUTION 250 MG/10ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00703367501",
      "ndc_label_name": "Methotrexate Sodium (PF) SOLUTION 250 MG/10ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027703",
      "ndc_label_name": "Methotrexate Sodium (PF) Solution 250 MG/10ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143951901",
      "ndc_label_name": "Methotrexate Sodium (PF) SOLUTION 50 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143951910",
      "ndc_label_name": "Methotrexate Sodium (PF) SOLUTION 50 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00703367101",
      "ndc_label_name": "Methotrexate Sodium (PF) SOLUTION 50 MG/2ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729027730",
      "ndc_label_name": "Methotrexate Sodium (PF) SOLUTION 50 MG/2ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63323012310",
      "ndc_label_name": "Methotrexate Sodium SOLUTION 250 MG/10ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61703016105",
      "ndc_label_name": "Methotrexate Sodium Solution 50 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61703035038",
      "ndc_label_name": "Methotrexate Sodium Solution 50 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61703035009",
      "ndc_label_name": "Methotrexate Sodium Solution 50 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61703016102",
      "ndc_label_name": "Methotrexate Sodium Solution 50 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61703035010",
      "ndc_label_name": "Methotrexate Sodium Solution 50 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61703035037",
      "ndc_label_name": "Methotrexate Sodium Solution 50 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079067001",
      "ndc_label_name": "Methotrexate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440775590",
      "ndc_label_name": "Methyldopa Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440775594",
      "ndc_label_name": "Methyldopa Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729003001",
      "ndc_label_name": "Methyldopa Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999009860",
      "ndc_label_name": "Methyldopa Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289073401",
      "ndc_label_name": "Methyldopa Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729003016",
      "ndc_label_name": "Methyldopa Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289073430",
      "ndc_label_name": "Methyldopa Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135032190",
      "ndc_label_name": "Methyldopa Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135032118",
      "ndc_label_name": "Methyldopa Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980057101",
      "ndc_label_name": "Methyldopa Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440775690",
      "ndc_label_name": "Methyldopa Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135032218",
      "ndc_label_name": "Methyldopa Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440775694",
      "ndc_label_name": "Methyldopa Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729003116",
      "ndc_label_name": "Methyldopa Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729003101",
      "ndc_label_name": "Methyldopa Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135032290",
      "ndc_label_name": "Methyldopa Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980057201",
      "ndc_label_name": "Methyldopa Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054063905",
      "ndc_label_name": "Methylergonovine Maleate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687081394",
      "ndc_label_name": "Methylergonovine Maleate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687041011",
      "ndc_label_name": "Methylergonovine Maleate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365522",
      "ndc_label_name": "Methylergonovine Maleate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093365528",
      "ndc_label_name": "Methylergonovine Maleate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571073528",
      "ndc_label_name": "Methylergonovine Maleate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571073521",
      "ndc_label_name": "Methylergonovine Maleate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904728210",
      "ndc_label_name": "Methylergonovine Maleate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054063913",
      "ndc_label_name": "Methylergonovine Maleate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078612",
      "ndc_label_name": "Methylergonovine Maleate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687081311",
      "ndc_label_name": "Methylergonovine Maleate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687041094",
      "ndc_label_name": "Methylergonovine Maleate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238160502",
      "ndc_label_name": "Methylergonovine Maleate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078628",
      "ndc_label_name": "Methylergonovine Maleate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238160508",
      "ndc_label_name": "Methylergonovine Maleate Tablet 0.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406181001",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093529501",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115173601",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527457937",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115173701",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406182001",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093529601",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527458037",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093529701",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115173801",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527458137",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406183001",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406184001",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115173901",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093529801",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527458237",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115174001",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093529201",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406185001",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527458337",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527458437",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115174101",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093529301",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406186001",
      "ndc_label_name": "Methylphenidate HCl ER (CD) Capsule Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714012401",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378815501",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722095201",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054511",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687053221",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629245901",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527331037",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591271501",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664060688",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378815577",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781041501",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10147068501",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629123101",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865013301",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407092401",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598043801",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62037072501",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811070610",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162023109",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291056890",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054512",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687053211",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559079001",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406012701",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378815601",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378815677",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811070710",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084081611",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591271601",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687054311",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10147068801",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714012501",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781041601",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527331137",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054612",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598043901",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664060788",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084081621",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722095301",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054611",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629246001",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687054321",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291056990",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407092501",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62037073401",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559079101",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629190201",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162023309",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865013401",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407092601",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811070810",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591271701",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378815701",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054711",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722095401",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406013601",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378815777",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055421",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781041701",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291057090",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714012601",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527331237",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664060888",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162023509",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10147068601",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591271730",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62037072601",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055411",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598044001",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629190301",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054712",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084082925",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629246101",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084082995",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865013501",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629246201",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378815801",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714012701",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054811",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811070910",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406015401",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10147068701",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378815877",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865013601",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527331337",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291057190",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591271830",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687056511",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591271801",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407092701",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598044101",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084083395",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687056521",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664060988",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781041801",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629190401",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722095501",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162023709",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054812",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62037072701",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084083325",
      "ndc_label_name": "Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781062901",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702007501",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406144501",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010004201",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052701",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702007506",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702007606",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407052801",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406147301",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702007601",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010004301",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781063101",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175031037",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 24 Hour 18 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175031137",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 24 Hour 27 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175031237",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 24 Hour 36 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175031337",
      "ndc_label_name": "Methylphenidate HCl ER Tablet Extended Release 24 Hour 54 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629117601",
      "ndc_label_name": "Methylphenidate HCl Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930002552",
      "ndc_label_name": "Methylphenidate HCl Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808005901",
      "ndc_label_name": "Methylphenidate HCl SOLUTION 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702016450",
      "ndc_label_name": "Methylphenidate HCl SOLUTION 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991061250",
      "ndc_label_name": "Methylphenidate HCl Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752013214",
      "ndc_label_name": "Methylphenidate HCl Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204105",
      "ndc_label_name": "Methylphenidate HCl Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162199305",
      "ndc_label_name": "Methylphenidate HCl Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808005801",
      "ndc_label_name": "Methylphenidate HCl SOLUTION 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991061150",
      "ndc_label_name": "Methylphenidate HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162199205",
      "ndc_label_name": "Methylphenidate HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121089605",
      "ndc_label_name": "Methylphenidate HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204005",
      "ndc_label_name": "Methylphenidate HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752013114",
      "ndc_label_name": "Methylphenidate HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121089620",
      "ndc_label_name": "Methylphenidate HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930002452",
      "ndc_label_name": "Methylphenidate HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702016350",
      "ndc_label_name": "Methylphenidate HCl SOLUTION 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406114401",
      "ndc_label_name": "Methylphenidate HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115180101",
      "ndc_label_name": "Methylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547048710",
      "ndc_label_name": "Methylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702010101",
      "ndc_label_name": "Methylphenidate HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629327902",
      "ndc_label_name": "Methylphenidate HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714082201",
      "ndc_label_name": "Methylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664022988",
      "ndc_label_name": "Methylphenidate HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729047901",
      "ndc_label_name": "Methylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722017401",
      "ndc_label_name": "Methylphenidate HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629192001",
      "ndc_label_name": "Methylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268052815",
      "ndc_label_name": "Methylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084082321",
      "ndc_label_name": "Methylphenidate HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629327903",
      "ndc_label_name": "Methylphenidate HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629947101",
      "ndc_label_name": "Methylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335296801",
      "ndc_label_name": "Methylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629327901",
      "ndc_label_name": "Methylphenidate HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877061701",
      "ndc_label_name": "Methylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242901",
      "ndc_label_name": "Methylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834032501",
      "ndc_label_name": "Methylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162208601",
      "ndc_label_name": "Methylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084082311",
      "ndc_label_name": "Methylphenidate HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865012301",
      "ndc_label_name": "Methylphenidate HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121902",
      "ndc_label_name": "Methylphenidate HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406114601",
      "ndc_label_name": "Methylphenidate HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714082301",
      "ndc_label_name": "Methylphenidate HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547048810",
      "ndc_label_name": "Methylphenidate HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729048001",
      "ndc_label_name": "Methylphenidate HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115180201",
      "ndc_label_name": "Methylphenidate HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702010201",
      "ndc_label_name": "Methylphenidate HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268052915",
      "ndc_label_name": "Methylphenidate HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162243001",
      "ndc_label_name": "Methylphenidate HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664023088",
      "ndc_label_name": "Methylphenidate HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162208701",
      "ndc_label_name": "Methylphenidate HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629947201",
      "ndc_label_name": "Methylphenidate HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722017501",
      "ndc_label_name": "Methylphenidate HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629192201",
      "ndc_label_name": "Methylphenidate HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877061801",
      "ndc_label_name": "Methylphenidate HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865012401",
      "ndc_label_name": "Methylphenidate HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834032601",
      "ndc_label_name": "Methylphenidate HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268052911",
      "ndc_label_name": "Methylphenidate HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834032401",
      "ndc_label_name": "Methylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714082101",
      "ndc_label_name": "Methylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162163601",
      "ndc_label_name": "Methylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629192401",
      "ndc_label_name": "Methylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115180001",
      "ndc_label_name": "Methylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406114201",
      "ndc_label_name": "Methylphenidate HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084080511",
      "ndc_label_name": "Methylphenidate HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547048610",
      "ndc_label_name": "Methylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702010001",
      "ndc_label_name": "Methylphenidate HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629947301",
      "ndc_label_name": "Methylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865012201",
      "ndc_label_name": "Methylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162201901",
      "ndc_label_name": "Methylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999084230",
      "ndc_label_name": "Methylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729047801",
      "ndc_label_name": "Methylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084080521",
      "ndc_label_name": "Methylphenidate HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664022888",
      "ndc_label_name": "Methylphenidate HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162201906",
      "ndc_label_name": "Methylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877061601",
      "ndc_label_name": "Methylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162242801",
      "ndc_label_name": "Methylphenidate HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722017301",
      "ndc_label_name": "Methylphenidate HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51552095804",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779014403",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592051111",
      "ndc_label_name": "MethylPREDNISolone Acetate Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779014406",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779014404",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552095802",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779014409",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991163502",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991163506",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779014405",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592051122",
      "ndc_label_name": "MethylPREDNISolone Acetate Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452468804",
      "ndc_label_name": "MethylPREDNISolone Acetate Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452468801",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779014408",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552095805",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991163504",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452468802",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452468803",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991163503",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927133200",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991163501",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452468805",
      "ndc_label_name": "MethylPREDNISolone Acetate Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991163505",
      "ndc_label_name": "MethylPREDNISolone Acetate POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452468806",
      "ndc_label_name": "MethylPREDNISolone Acetate Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592051101",
      "ndc_label_name": "MethylPREDNISolone Acetate Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592051125",
      "ndc_label_name": "MethylPREDNISolone Acetate Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219157305",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703003101",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703004501",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219157301",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121160901",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714008825",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703004301",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781352275",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71283062502",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703003104",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781352270",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714008801",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714008901",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023023801",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090589400",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714009001",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021082005",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150031301",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023023901",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021082010",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69852011510",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121157305",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121157301",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121160905",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 40 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71283063601",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714047301",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703006301",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219157405",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714047225",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121155201",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703005101",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69852091610",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219157401",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021082105",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781351675",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121161001",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62295311901",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266107501",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703005104",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121157401",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121157405",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150031401",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714047201",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71266106501",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090602400",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121155205",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023024001",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71283063402",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121161005",
      "ndc_label_name": "MethylPREDNISolone Acetate Suspension 80 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452468605",
      "ndc_label_name": "MethylPREDNISolone Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452468601",
      "ndc_label_name": "MethylPREDNISolone POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452468603",
      "ndc_label_name": "MethylPREDNISolone POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452468602",
      "ndc_label_name": "MethylPREDNISolone POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552060304",
      "ndc_label_name": "MethylPREDNISolone POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552060302",
      "ndc_label_name": "MethylPREDNISolone POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991290302",
      "ndc_label_name": "MethylPREDNISolone POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991290303",
      "ndc_label_name": "MethylPREDNISolone POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991290301",
      "ndc_label_name": "MethylPREDNISolone POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927228700",
      "ndc_label_name": "MethylPREDNISolone POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55390021901",
      "ndc_label_name": "MethylPREDNISolone Sodium Succ SOLUTION RECONSTITUTED 1 GM INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598013074",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 1000 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985101",
      "ndc_label_name": "MethylPREDNISolone Sodium Succ Solution Reconstituted 1000 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323026530",
      "ndc_label_name": "MethylPREDNISolone Sodium Succ SOLUTION RECONSTITUTED 1000 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598012901",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 125 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323025801",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 125 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143975401",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 125 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598012925",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 125 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323025803",
      "ndc_label_name": "MethylPREDNISolone Sodium Succ SOLUTION RECONSTITUTED 125 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121100101",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 125 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143975425",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 125 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572009825",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 125 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121100105",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 125 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518312800",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 125 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70518312801",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 125 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572009801",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 125 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143975325",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 40 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323025503",
      "ndc_label_name": "MethylPREDNISolone Sodium Succ SOLUTION RECONSTITUTED 40 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121100005",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 40 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143975301",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 40 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572009701",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 40 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121100001",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 40 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572009725",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 40 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598012745",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 40 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598012725",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 40 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323025501",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 40 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143985001",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 500 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598012811",
      "ndc_label_name": "methylPREDNISolone Sodium Succ Solution Reconstituted 500 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762005101",
      "ndc_label_name": "MethylPREDNISolone TABLET 32 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746001504",
      "ndc_label_name": "MethylPREDNISolone TABLET 32 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001056055",
      "ndc_label_name": "methylPREDNISolone Tablet 32 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382091911",
      "ndc_label_name": "MethylPREDNISolone Tablet 32 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135076326",
      "ndc_label_name": "methylPREDNISolone Tablet 32 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121157610",
      "ndc_label_name": "Metoclopramide HCl Solution 10 MG/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999052610",
      "ndc_label_name": "Metoclopramide HCl Solution 10 MG/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135052624",
      "ndc_label_name": "Metoclopramide HCl Solution 10 MG/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121057610",
      "ndc_label_name": "Metoclopramide HCl Solution 10 MG/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999052624",
      "ndc_label_name": "Metoclopramide HCl Solution 10 MG/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121057616",
      "ndc_label_name": "Metoclopramide HCl Solution 10 MG/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135052610",
      "ndc_label_name": "Metoclopramide HCl Solution 10 MG/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440777195",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440777130",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093220310",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228023301",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440777106",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093220305",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093220301",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440777108",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080860",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884068901",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999005700",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959048060",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440777190",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027453",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440777104",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440777191",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884068905",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999005730",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999005710",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063111",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999005712",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080853",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291059690",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080760",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090013200",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079088820",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228023310",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304084605",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079088801",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919015130",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999005790",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090222100",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228023305",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559029601",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959048030",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788722603",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063101",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788793003",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959048000",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629874501",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304084610",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980001105",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304084601",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980001110",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187023530",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980001101",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267028630",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788679103",
      "ndc_label_name": "Metoclopramide HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093220401",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291059590",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093220405",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228023201",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440777008",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084930",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079088601",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187040403",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228023205",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079088620",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440777006",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980001001",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084960",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687062001",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687062011",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559029501",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980001005",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304084501",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919015090",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267050030",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304084505",
      "ndc_label_name": "Metoclopramide HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657094210",
      "ndc_label_name": "metOLazone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378617401",
      "ndc_label_name": "Metolazone TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657074201",
      "ndc_label_name": "metOLazone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657094201",
      "ndc_label_name": "metOLazone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440777710",
      "ndc_label_name": "metOLazone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332053431",
      "ndc_label_name": "Metolazone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185560001",
      "ndc_label_name": "Metolazone TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135076701",
      "ndc_label_name": "metOLazone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71406011501",
      "ndc_label_name": "metOLazone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527221737",
      "ndc_label_name": "metOLazone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292056601",
      "ndc_label_name": "Metolazone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888005401",
      "ndc_label_name": "Metolazone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742035101",
      "ndc_label_name": "metOLazone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81005012601",
      "ndc_label_name": "metOLazone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407043301",
      "ndc_label_name": "Metolazone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385013801",
      "ndc_label_name": "Metolazone Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378617201",
      "ndc_label_name": "Metolazone TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185505001",
      "ndc_label_name": "Metolazone TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353089009",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904732861",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904713861",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904752061",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527221537",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135076501",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090680200",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079002320",
      "ndc_label_name": "Metolazone TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407043101",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099909",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657074001",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687053601",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657094010",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742034901",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090697200",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657094001",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687053611",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079002301",
      "ndc_label_name": "Metolazone TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687062401",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292056201",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332053231",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687062411",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629872201",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162105601",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014209",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028509",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71406011301",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888005201",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81005012401",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385013601",
      "ndc_label_name": "metOLazone Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527221637",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079002420",
      "ndc_label_name": "Metolazone TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185005510",
      "ndc_label_name": "Metolazone TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378617301",
      "ndc_label_name": "Metolazone TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185005501",
      "ndc_label_name": "Metolazone TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063501",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063511",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904713961",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904732961",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335285001",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904752161",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135076601",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353093109",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629873301",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079002401",
      "ndc_label_name": "Metolazone TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162105001",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742035001",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028609",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657094101",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407043201",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657074101",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71406011401",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332053331",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385013701",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292056401",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888005301",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657094110",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81005012501",
      "ndc_label_name": "metOLazone Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808030403",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979003903",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378459777",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378459710",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527260237",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963067796",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527260243",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079560",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722059101",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808030402",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085403",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904632461",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072605",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079516",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090158600",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090384701",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072601",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808030401",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085401",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090384700",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629917201",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090541301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090338301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054211",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072610",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722059105",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085402",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090572100",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001047000",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648400",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090695900",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407040501",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090158601",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722059110",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979003901",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50816010003",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001050203",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090707000",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742061701",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111046801",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090338300",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963067711",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979003902",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919076130",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809806",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742061710",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50816010002",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700023290",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090541101",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090541100",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063084130",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629886501",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809809",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407040510",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111046805",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687041365",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090572000",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090706901",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090626000",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679084803",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825503",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919076190",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700023230",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760049290",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090572001",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054215",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090626001",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877059210",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097040807",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382056610",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760063590",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001047008",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090695901",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079017101",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090696000",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001035800",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205080130",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726303",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877059205",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001068600",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090706900",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687041311",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742061705",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001050200",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610050960",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726306",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001035803",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079017103",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919033490",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760056390",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809801",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516002710",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726309",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001068603",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809803",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687041301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629917101",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877059201",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825506",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834029200",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825509",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788844803",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825501",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760066390",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679084802",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645047954",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934050230",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009011505",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078205",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078201",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788844806",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679084810",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001011903",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097040815",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934072590",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382056601",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205033690",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205068390",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078210",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788844801",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788726302",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934072530",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048460",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788844809",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610050945",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205080190",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436016602",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516003210",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436016601",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205033630",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162185800",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335016704",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603014401",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335016701",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934050290",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048445",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335016703",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335016702",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162185805",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055860",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907034501",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055845",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603014403",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516003201",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335016705",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162185801",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603014402",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516003250",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335016706",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834029205",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834029201",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907034510",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808030501",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085501",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054315",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527260343",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722059210",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378459805",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085502",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742061801",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072705",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629886601",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50816020003",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722059205",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072701",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378459877",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072710",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50816020002",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054311",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877059301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001068700",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742061805",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963067811",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527260337",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742061810",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679084902",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407040601",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603014501",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097040907",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407040608",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078305",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979004001",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111046905",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001047100",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078310",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722059201",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057360",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407040610",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162185901",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877059305",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629917301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001050300",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834029300",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001036000",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834029301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111046901",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907034601",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049660",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382056705",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436016702",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162185905",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057345",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382056701",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516002801",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049645",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436016701",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162185900",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516003301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834029305",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603014502",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907034605",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009011605",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904632206",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979003701",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808030203",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085203",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378459510",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378459577",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904632261",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063062460",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085201",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722058905",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063062490",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979003702",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808030202",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527260037",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072401",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963070996",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808030201",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090101001",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001645",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722058901",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090374600",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527260043",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072405",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090374601",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063062430",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090609700",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001660",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722058910",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090539401",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085202",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090101000",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573300",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759000",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090711701",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963070911",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648603",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090541800",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979003703",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090541801",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648700",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079016901",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742061501",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090374603",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648801",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090541803",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072410",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648600",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759100",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111046605",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50816002503",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573303",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759001",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648803",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648601",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687039065",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687039011",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407040310",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054011",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50816002502",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090609701",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648900",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090711800",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629886301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788720601",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919075490",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097690",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407040301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090609703",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090711703",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742061505",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679084603",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788720603",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001068403",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001035603",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629916801",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090648800",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700025330",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111046601",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001050000",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189038030",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788806906",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001068400",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679084602",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090711700",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700025390",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629916701",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078005",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603014203",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788806909",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402209",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001050003",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054015",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877059005",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679084610",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078010",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010730",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078001",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788720602",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436020201",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742061510",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402203",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877059010",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934026790",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907034410",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934011330",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848603",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205036890",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079016920",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788402206",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001035600",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335015802",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687039001",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934054230",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848609",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162185601",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877059001",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788720606",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382056410",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834029005",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382056401",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516003001",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436020202",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009011305",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788720609",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016160",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645047754",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804025290",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848606",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789010790",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335283401",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804026290",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016145",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048345",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788806903",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048360",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051245",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051260",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934026730",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162185600",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055545",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162185605",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205036830",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189065290",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055560",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603014201",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516003010",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834029000",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516003050",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834029001",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603014202",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907034401",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072501",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979003802",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378459677",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904632361",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085303",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527260137",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378459610",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090539201",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808030303",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808030301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714085302",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722059001",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527260143",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979003801",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722059005",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090572300",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072510",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806072505",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058330",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090196501",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808030302",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979003803",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722059010",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090595000",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353017380",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058345",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058360",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090572200",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066330",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090104901",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353017360",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090651000",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090380800",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963067611",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090644800",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629886401",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963067696",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090723801",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090104900",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666300",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090595001",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666201",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50816005002",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629916901",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090644801",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079017020",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090196500",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742061610",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666200",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079017001",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919072790",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877059105",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111046705",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919091330",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090380801",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50816005003",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090723900",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407040410",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919090090",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877059110",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687040201",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739009710",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090572201",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407040401",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054115",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687040211",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679084710",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382056501",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760099390",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645047854",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090723800",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111046701",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742061605",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679084703",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831209",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382056510",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001035700",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771802",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268054111",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700019290",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700019230",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001035703",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097040707",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771801",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001050103",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799701",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742061601",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760061690",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687040265",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001046908",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436018302",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771806",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001068500",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886906",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760049390",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679084702",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760063490",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001050100",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061230",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799706",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001068503",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078105",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877059101",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001046900",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629917001",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771809",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335975303",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886903",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832701",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436018301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799709",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831203",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771803",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831201",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516003101",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016290",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078110",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516002610",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832709",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831206",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799703",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934038830",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886909",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205080030",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205017930",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603014303",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934038890",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832703",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010078101",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335014903",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205017990",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335283501",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162185700",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789028430",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064253",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832706",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603014302",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064260",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189054790",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162185701",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789028490",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834029100",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516003110",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097040715",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907034701",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603014301",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834029101",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001030",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907034710",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804001430",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008003090",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934061290",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804019890",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804001490",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834029105",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006890",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064245",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009011405",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516003150",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014530",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049790",
      "ndc_label_name": "Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778630",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778606",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094453",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999022600",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378004701",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356078290",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378004710",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778660",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063093860",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048903",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090197403",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090774004",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778692",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063093890",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094480",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778694",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048901",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090774000",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090226003",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343006101",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063093830",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094460",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048904",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063093893",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090197404",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407011101",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090756903",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343006199",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090226000",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999022630",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090197401",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048900",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664016758",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817036210",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090774001",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304058101",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090676400",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090756901",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757000",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090197400",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919042890",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664016708",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090774100",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267034693",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090774003",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090756904",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817025410",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090226001",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304058110",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760029590",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817025400",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544013045",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664016752",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817036200",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237010299",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090226004",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105099606",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934045490",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237010201",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824901",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760056690",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862006439",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544013053",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090748800",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544013030",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335024101",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332011431",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824903",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105099611",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862006499",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335024102",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090756900",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544013060",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055180",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332011491",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888501",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824906",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105099615",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105099603",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407011110",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544013080",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888021201",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105099610",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367035510",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335024104",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544013070",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645019159",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584026701",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888506",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097955",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018653",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934071990",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008080",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824909",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055953",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584026711",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335024105",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888503",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282079601",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055160",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097911",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888509",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008053",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862006401",
      "ndc_label_name": "Metoprolol Tartrate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008060",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335024103",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018680",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934045430",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055960",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018660",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055980",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189054490",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097900",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888000600",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097990",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888000601",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097930",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888021200",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282079610",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097960",
      "ndc_label_name": "Metoprolol Tartrate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778445",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094260",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378001801",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378001805",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220700",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220701",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092701",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778490",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092730",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736200",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094292",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092714",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090756703",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220702",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092793",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094298",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092790",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090756800",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090507000",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092760",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005290",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736203",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736201",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999057590",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736300",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343005901",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090756700",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094230",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070560",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817036000",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773802",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220703",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773803",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237010001",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090756702",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094253",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070590",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289038293",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079025501",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736202",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343005999",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332011291",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010910",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094270",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584026511",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050652",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817025000",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773800",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817036010",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584026501",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289038230",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094280",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544038730",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050658",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817025010",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773801",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289038214",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544038760",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289038290",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090756701",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544038753",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005230",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304057901",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773900",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237010099",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783201",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544038798",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010901",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733809",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544038770",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862006201",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079025520",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332011231",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820709",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733801",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919005260",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884009",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733806",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788850901",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544038792",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544038780",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788850903",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783209",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304057910",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934050090",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783206",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884003",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733803",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884006",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788850909",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820701",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862006299",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335074302",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934050030",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018460",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788783203",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934039090",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934039030",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820703",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071028830",
      "ndc_label_name": "Metoprolol Tartrate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282079401",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013780",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051780",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788850906",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007380",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000390",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820706",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884001",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055645",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051753",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055630",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000360",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055692",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335074301",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055653",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051760",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888000400",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018453",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189064030",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007360",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888020800",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055680",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282079410",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055660",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888020801",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888000401",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013760",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888020805",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055670",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018480",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189064090",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055698",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888000405",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888020802",
      "ndc_label_name": "Metoprolol Tartrate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778545",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094330",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378003201",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778528",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778520",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378003210",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904711861",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778506",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778594",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094394",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082190",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778530",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094345",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778560",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356041530",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778592",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094360",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048801",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082193",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082130",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094373",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440778590",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063082160",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048804",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094370",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090197904",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048805",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094392",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001060",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094380",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094353",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090214900",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094398",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090214905",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090197900",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001000",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090214901",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079080120",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090214904",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090755300",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048800",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090607600",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090197905",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999001030",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090506000",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959083930",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090288900",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090755305",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608300",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959083960",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090755400",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090197901",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608304",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919031790",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090755301",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817036100",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608301",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664016618",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343006099",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608400",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090608305",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862006399",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343006001",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817036110",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090755304",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664047758",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760068060",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407011010",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407011001",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544007670",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817025210",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237010101",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079080101",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760024360",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105099403",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700064690",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817025200",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544007692",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664047752",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862006359",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700064630",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760052498",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645019059",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584026611",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237010199",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788754806",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105099411",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105099406",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760042698",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919072690",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888609",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544007660",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760024398",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788754809",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821106",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544007680",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760055360",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332011391",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934010596",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888601",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760042660",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821103",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934010530",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788754801",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760055398",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304058001",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934073660",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934035190",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332011331",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821109",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044380",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014792",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919041590",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888603",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044370",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014770",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584026601",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934030590",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056573",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044360",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919072660",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788888606",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056530",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014780",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304058010",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934035130",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056594",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044392",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919072682",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934030560",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097860",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056570",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105099410",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014794",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888000501",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044394",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862006301",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934073690",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097890",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056592",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105099415",
      "ndc_label_name": "Metoprolol Tartrate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054860",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888021000",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789053590",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934030530",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013860",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888021001",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888000500",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788754803",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054880",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097855",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804025390",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009160",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056560",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821101",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282079510",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013892",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056598",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367035410",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097811",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014760",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789054993",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934073630",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056553",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013870",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056580",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013880",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015860",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015880",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056545",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888021002",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282079501",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804016590",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097800",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097830",
      "ndc_label_name": "Metoprolol Tartrate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168032346",
      "ndc_label_name": "MetroNIDAZOLE CREAM 0.75 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993096045",
      "ndc_label_name": "MetroNIDAZOLE Cream 0.75 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713075737",
      "ndc_label_name": "metroNIDAZOLE Cream 0.75 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651077046",
      "ndc_label_name": "metroNIDAZOLE Cream 0.75 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788855204",
      "ndc_label_name": "metroNIDAZOLE Cream 0.75 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118993304",
      "ndc_label_name": "MetroNIDAZOLE CREAM 0.75 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713063337",
      "ndc_label_name": "MetroNIDAZOLE CREAM 0.75 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189030645",
      "ndc_label_name": "metroNIDAZOLE Cream 0.75 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308071145",
      "ndc_label_name": "metroNIDAZOLE Cream 0.75 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578012908",
      "ndc_label_name": "metroNIDAZOLE Cream 0.75 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115147446",
      "ndc_label_name": "MetroNIDAZOLE Gel 0.75 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713063737",
      "ndc_label_name": "MetroNIDAZOLE GEL 0.75 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672411606",
      "ndc_label_name": "MetroNIDAZOLE GEL 0.75 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21922007006",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168027545",
      "ndc_label_name": "MetroNIDAZOLE Gel 0.75 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42546070045",
      "ndc_label_name": "MetroNIDAZOLE Gel 0.75 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993096245",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72578020904",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781707787",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713057571",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090101200",
      "ndc_label_name": "MetroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682045570",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714055701",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71656006770",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802013970",
      "ndc_label_name": "MetroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090212600",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922003923",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462018449",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090716000",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090734500",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090480900",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629868001",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629873101",
      "ndc_label_name": "metroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002073499",
      "ndc_label_name": "MetroNIDAZOLE GEL 0.75 % VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73473030370",
      "ndc_label_name": "MetroNIDAZOLE Gel 0.75 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168038360",
      "ndc_label_name": "MetroNIDAZOLE LOTION 0.75 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66993096159",
      "ndc_label_name": "MetroNIDAZOLE Lotion 0.75 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68308071259",
      "ndc_label_name": "metroNIDAZOLE Lotion 0.75 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440779528",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440779521",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071906",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904145361",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440179528",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440779514",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440779504",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440779508",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440779581",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571066550",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090020201",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071956",
      "ndc_label_name": "MetroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999031300",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440779530",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440779506",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904715661",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155065105",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300022605",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380077906",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052601",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090020101",
      "ndc_label_name": "MetroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155065101",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571066501",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999031321",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300022601",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071921",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380077907",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919038521",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090020200",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300022652",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071928",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090020102",
      "ndc_label_name": "MetroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040056",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071930",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380077925",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292020750",
      "ndc_label_name": "MetroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090322000",
      "ndc_label_name": "MetroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090020100",
      "ndc_label_name": "MetroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999031328",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090569101",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093305",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999031330",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090569100",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019506",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919038514",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268053415",
      "ndc_label_name": "MetroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111033306",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111033301",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980023501",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090569102",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332001631",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019530",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135079590",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040021",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980023525",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111033302",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001036400",
      "ndc_label_name": "MetroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407037601",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795501",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268053411",
      "ndc_label_name": "MetroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187051128",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348074508",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795504",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040015",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71709012904",
      "ndc_label_name": "MetroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407037605",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578000705",
      "ndc_label_name": "MetroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040030",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788823002",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052611",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518001300",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348074521",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578000701",
      "ndc_label_name": "MetroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348074528",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332001671",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380077938",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862069405",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093301",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795503",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862069401",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795506",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919038528",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862069425",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919038530",
      "ndc_label_name": "MetroNIDAZOLE TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795502",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049921",
      "ndc_label_name": "MetroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980023505",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71709012906",
      "ndc_label_name": "MetroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578000721",
      "ndc_label_name": "MetroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789019521",
      "ndc_label_name": "metroNIDAZOLE Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155065205",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440179614",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155065201",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073804",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300022701",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440779621",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090021109",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440779604",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090021106",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300022746",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073828",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073814",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073806",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073821",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251200",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440779614",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090524900",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090302401",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073830",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090021300",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073809",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073879",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251300",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904712661",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090568704",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306306",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090021100",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090252102",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090021103",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306300",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090252101",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571066401",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090568801",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090568700",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090021201",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959010204",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251204",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306304",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090524903",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571066450",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111033401",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090568703",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251203",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959010220",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407037201",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306309",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268053515",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300022705",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959010214",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111033402",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251206",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959010242",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959010221",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090568709",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700029804",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090021104",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002024704",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268053511",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251209",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348074004",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052108",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407037205",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093405",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090021202",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052114",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959010215",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306303",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052125",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052110",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959010208",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036330",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090021400",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052121",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959010228",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090310900",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657093401",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700029830",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959010230",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332001731",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090568706",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052140",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348074028",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090568802",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055011",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090914",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002024714",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187003530",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348074010",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687055001",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052130",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052128",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380078006",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760033614",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348074014",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380078007",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052104",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760066440",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052179",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090930",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980023650",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760066414",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052106",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380078025",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760053914",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003214",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090921",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003204",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001036500",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919078830",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289052109",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693001",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187003528",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003221",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760053940",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332001771",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001036503",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135079690",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700029814",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693004",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082704",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187003514",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003230",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187003504",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693002",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082730",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700029821",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867401",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082721",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082714",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980023605",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629138604",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781502",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629138607",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090904",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867404",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629138605",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862069550",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693007",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629138606",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035808",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862069501",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919003210",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934027620",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629138608",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788693003",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008804",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781507",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000514",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781504",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862069505",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035807",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980023601",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008800",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934080121",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867407",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000709",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781505",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781501",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000779",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781503",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008802",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934080130",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518005801",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000728",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867402",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867403",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001114",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518005804",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035804",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035800",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934010421",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008803",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788867405",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292020850",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934043621",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008805",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71709013004",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035806",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934080114",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934010414",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934010420",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162240302",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035801",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035802",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71709013006",
      "ndc_label_name": "MetroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035809",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035803",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335035805",
      "ndc_label_name": "MetroNIDAZOLE TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934010430",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578000805",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000704",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578000818",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001104",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000730",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000714",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934081321",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000721",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578000801",
      "ndc_label_name": "metroNIDAZOLE Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742023901",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722003601",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756095501",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559082001",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093873901",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687077811",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407037901",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135073001",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527410737",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629214501",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687077821",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335292201",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980066601",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629929001",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162177201",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062401",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162178201",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629917901",
      "ndc_label_name": "Mexiletine HCl Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135073101",
      "ndc_label_name": "Mexiletine HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062501",
      "ndc_label_name": "Mexiletine HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527410837",
      "ndc_label_name": "Mexiletine HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407038001",
      "ndc_label_name": "Mexiletine HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093874001",
      "ndc_label_name": "Mexiletine HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162178301",
      "ndc_label_name": "Mexiletine HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559082101",
      "ndc_label_name": "Mexiletine HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162177301",
      "ndc_label_name": "Mexiletine HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722003701",
      "ndc_label_name": "Mexiletine HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756095601",
      "ndc_label_name": "Mexiletine HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742024001",
      "ndc_label_name": "Mexiletine HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335292801",
      "ndc_label_name": "Mexiletine HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629196301",
      "ndc_label_name": "Mexiletine HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980066701",
      "ndc_label_name": "Mexiletine HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629918001",
      "ndc_label_name": "Mexiletine HCl Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742024101",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527410937",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135073201",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559082201",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980066801",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722003801",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093874101",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756095701",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162178401",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062601",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999091790",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135078590",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407038101",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629196401",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629918101",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162177401",
      "ndc_label_name": "Mexiletine HCl Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00363008100",
      "ndc_label_name": "Miconazole 3 Combo-Supp Kit 200 & 2 MG-% (9GM) Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904541501",
      "ndc_label_name": "Miconazole 3 Combo-Supp Kit 200 & 2 MG-% (9GM) Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000002501",
      "ndc_label_name": "Miconazole 3 Combo-Supp Kit 200 & 2 MG-% (9GM) Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113008100",
      "ndc_label_name": "Miconazole 3 Combo-Supp Kit 200 & 2 MG-% (9GM) Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800008100",
      "ndc_label_name": "Miconazole 3 Combo-Supp Kit 200 & 2 MG-% (9GM) Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000002502",
      "ndc_label_name": "Miconazole 3 Combo-Supp Kit 200 & 2 MG-% (9GM) Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51672207009",
      "ndc_label_name": "Miconazole 3 Cream 4 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113021429",
      "ndc_label_name": "Miconazole 7 CREAM 2 % VAGINAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800082529",
      "ndc_label_name": "Miconazole 7 CREAM 2 % VAGINAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49022008441",
      "ndc_label_name": "Miconazole 7 CREAM 2 % VAGINAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30142082529",
      "ndc_label_name": "Miconazole 7 Cream 2 % Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113082529",
      "ndc_label_name": "Miconazole 7 CREAM 2 % VAGINAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61269073041",
      "ndc_label_name": "Miconazole 7 Cream 2 % Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30142021429",
      "ndc_label_name": "Miconazole 7 Cream 2 % Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904773445",
      "ndc_label_name": "Miconazole 7 CREAM 2 % VAGINAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61269073063",
      "ndc_label_name": "Miconazole 7 Cream 2 % Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49022008444",
      "ndc_label_name": "Miconazole 7 CREAM 2 % VAGINAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49614059029",
      "ndc_label_name": "Miconazole 7 Cream 2 % Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000000901",
      "ndc_label_name": "Miconazole 7 Cream 2 % Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61269073607",
      "ndc_label_name": "Miconazole 7 Suppository 100 MG Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49022008437",
      "ndc_label_name": "Miconazole 7 Suppository 100 MG Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68788884503",
      "ndc_label_name": "Miconazole Antifungal Cream 2 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69396001420",
      "ndc_label_name": "Miconazole Antifungal CREAM 2 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00562780605",
      "ndc_label_name": "MICRhoGAM Ultra-Filtered Plus Solution Prefilled Syringe 250 UNIT Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00562780601",
      "ndc_label_name": "MICRhoGAM Ultra-Filtered Plus Solution Prefilled Syringe 250 UNIT Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00562780600",
      "ndc_label_name": "MICRhoGAM Ultra-Filtered Plus Solution Prefilled Syringe 250 UNIT Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00562780625",
      "ndc_label_name": "MICRhoGAM Ultra-Filtered Plus Solution Prefilled Syringe 250 UNIT Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268056311",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378190301",
      "ndc_label_name": "Midodrine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700015901",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268056315",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687040995",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817032510",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291056290",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245021311",
      "ndc_label_name": "Midodrine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407039090",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884087401",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090630",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687040925",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629234601",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980043501",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162255901",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904681907",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505132501",
      "ndc_label_name": "Midodrine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651024801",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82293000510",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756005011",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090660",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382073901",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090690",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090672",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046701",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332034031",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046790",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011401",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090611",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469014190",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090600",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603060701",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090655",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162197501",
      "ndc_label_name": "Midodrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245021111",
      "ndc_label_name": "Midodrine HCl TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378190101",
      "ndc_label_name": "Midodrine HCl TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268056111",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407038890",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505132001",
      "ndc_label_name": "Midodrine HCl TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291056090",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904681761",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884081401",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904681706",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268056115",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382073701",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038701",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090411",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817032310",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090490",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332033831",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651024601",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090430",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469013990",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335303701",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162151701",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038711",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629222701",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700015701",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011201",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046590",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090455",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756001011",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090472",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629234801",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162197301",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090460",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980043301",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046501",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090400",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162256001",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603060501",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82293000310",
      "ndc_label_name": "Midodrine HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629234701",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245021201",
      "ndc_label_name": "Midodrine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756004911",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245021289",
      "ndc_label_name": "Midodrine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079045301",
      "ndc_label_name": "Midodrine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245021211",
      "ndc_label_name": "Midodrine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884084901",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378190201",
      "ndc_label_name": "Midodrine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700015801",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268056211",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090511",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888011301",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980043401",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904681861",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268056215",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904681806",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090500",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079045320",
      "ndc_label_name": "Midodrine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817032410",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82293000410",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382073801",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651024701",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505132101",
      "ndc_label_name": "Midodrine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291056190",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603060601",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407038990",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090555",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687039801",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090560",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739014510",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81469014090",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687039811",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046890",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090590",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332033931",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090572",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090530",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162256101",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162197401",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046801",
      "ndc_label_name": "Midodrine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121094010",
      "ndc_label_name": "Milk of Magnesia Concentrate Suspension 2400 MG/10ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121052710",
      "ndc_label_name": "Milk of Magnesia Concentrate Suspension 2400 MG/10ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121094000",
      "ndc_label_name": "Milk of Magnesia Concentrate Suspension 2400 MG/10ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904684072",
      "ndc_label_name": "Milk of Magnesia Concentrate Suspension 2400 MG/10ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000006101",
      "ndc_label_name": "Milk of Magnesia Suspension 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "75450029758",
      "ndc_label_name": "Milk of Magnesia SUSPENSION 1200 MG/15ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "75450029485",
      "ndc_label_name": "Milk of Magnesia SUSPENSION 1200 MG/15ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536131983",
      "ndc_label_name": "Milk of Magnesia Suspension 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113039640",
      "ndc_label_name": "Milk of Magnesia Suspension 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015179",
      "ndc_label_name": "Milk of Magnesia Suspension 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00113033240",
      "ndc_label_name": "Milk of Magnesia Suspension 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015181",
      "ndc_label_name": "Milk of Magnesia Suspension 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000006501",
      "ndc_label_name": "Milk of Magnesia Suspension 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015595",
      "ndc_label_name": "Milk of Magnesia SUSPENSION 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917011505",
      "ndc_label_name": "Milk of Magnesia SUSPENSION 1200 MG/15ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015176",
      "ndc_label_name": "Milk of Magnesia Suspension 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015593",
      "ndc_label_name": "Milk of Magnesia SUSPENSION 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896064712",
      "ndc_label_name": "Milk of Magnesia Suspension 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015594",
      "ndc_label_name": "Milk of Magnesia Suspension 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015592",
      "ndc_label_name": "Milk of Magnesia SUSPENSION 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896064812",
      "ndc_label_name": "Milk of Magnesia Suspension 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68788863803",
      "ndc_label_name": "Milk of Magnesia Suspension 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917016878",
      "ndc_label_name": "Milk of Magnesia Suspension 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800064912",
      "ndc_label_name": "Milk of Magnesia Suspension 1200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800024712",
      "ndc_label_name": "Mineral Oil OIL ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00363083145",
      "ndc_label_name": "Mineral Oil OIL ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00363083143",
      "ndc_label_name": "Mineral Oil OIL ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917010658",
      "ndc_label_name": "Mineral Oil OIL ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000044801",
      "ndc_label_name": "Mineral Oil Oil Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00869083143",
      "ndc_label_name": "Mineral Oil OIL ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17856111001",
      "ndc_label_name": "Mineral Oil Oil Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015471",
      "ndc_label_name": "Mineral Oil OIL ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033004230",
      "ndc_label_name": "Mineral Oil Oil Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "48433020230",
      "ndc_label_name": "Mineral Oil OIL ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033004250",
      "ndc_label_name": "Mineral Oil Oil Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295013507",
      "ndc_label_name": "Minerin Creme Cream External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904775127",
      "ndc_label_name": "Minerin Creme Cream External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681015500",
      "ndc_label_name": "Minerin Creme Cream External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08373689800",
      "ndc_label_name": "MiniElite Filter Replacements",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904688806",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440780560",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062005",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668048450",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591569550",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062050",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073620",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073630",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668048405",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999050507",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090257904",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073614",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090369702",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073660",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781054605",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090369700",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353090983",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090233902",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090369703",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010583",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090369704",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090257900",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781054650",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919033720",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090233900",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289020130",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289020120",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090233904",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289020114",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919033730",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700041530",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056030",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090233903",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700041560",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700041520",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090257903",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687033665",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187085021",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705201",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705203",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090257902",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919027030",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056020",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304069650",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919027020",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304069605",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004214",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004603",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664085385",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788826503",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809702",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705202",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862021105",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809701",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004600",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004608",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687033611",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788826506",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004604",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934062430",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004220",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809706",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004605",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162257402",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862021150",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004609",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335112304",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205027230",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004606",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004230",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162257405",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031403",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382031818",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335112306",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031402",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004601",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004607",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031401",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039001",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039003",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809703",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335112301",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039002",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335112302",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788826501",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788826502",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205027221",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205051130",
      "ndc_label_name": "Minocycline HCl Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335004602",
      "ndc_label_name": "Minocycline HCl CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090571000",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090571003",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591569401",
      "ndc_label_name": "Minocycline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090063203",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999050407",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090364403",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591569460",
      "ndc_label_name": "Minocycline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668048201",
      "ndc_label_name": "Minocycline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084530",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009720",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025016",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090364400",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999050428",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781054401",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353093016",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919059530",
      "ndc_label_name": "Minocycline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862020901",
      "ndc_label_name": "Minocycline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090297100",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700064990",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304069401",
      "ndc_label_name": "Minocycline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090063200",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090301600",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664085188",
      "ndc_label_name": "Minocycline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205008660",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289020230",
      "ndc_label_name": "Minocycline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090301603",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004160",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162257301",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382031601",
      "ndc_label_name": "Minocycline HCl CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004120",
      "ndc_label_name": "Minocycline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591564301",
      "ndc_label_name": "Minoxidil TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090776002",
      "ndc_label_name": "Minoxidil Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629929901",
      "ndc_label_name": "Minoxidil Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291061901",
      "ndc_label_name": "Minoxidil Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162149005",
      "ndc_label_name": "Minoxidil Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489038701",
      "ndc_label_name": "Minoxidil TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591564305",
      "ndc_label_name": "Minoxidil TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084020501",
      "ndc_label_name": "Minoxidil TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884025701",
      "ndc_label_name": "Minoxidil TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629223001",
      "ndc_label_name": "Minoxidil Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884025705",
      "ndc_label_name": "Minoxidil TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084020511",
      "ndc_label_name": "Minoxidil TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407090201",
      "ndc_label_name": "Minoxidil Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027901",
      "ndc_label_name": "Minoxidil Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629223101",
      "ndc_label_name": "Minoxidil Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489038601",
      "ndc_label_name": "Minoxidil TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291061801",
      "ndc_label_name": "Minoxidil Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034209",
      "ndc_label_name": "Minoxidil Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084020401",
      "ndc_label_name": "Minoxidil TABLET 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591564201",
      "ndc_label_name": "Minoxidil TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591564205",
      "ndc_label_name": "Minoxidil TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629223201",
      "ndc_label_name": "Minoxidil Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884025601",
      "ndc_label_name": "Minoxidil TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407090101",
      "ndc_label_name": "Minoxidil Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084020411",
      "ndc_label_name": "Minoxidil TABLET 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027801",
      "ndc_label_name": "Minoxidil Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090775800",
      "ndc_label_name": "Minoxidil Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827303",
      "ndc_label_name": "Minoxidil Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804024030",
      "ndc_label_name": "Minoxidil Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162148901",
      "ndc_label_name": "Minoxidil Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904670060",
      "ndc_label_name": "Mintox Plus TABLET CHEWABLE 200-200-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50419042301",
      "ndc_label_name": "Mirena (52 MG) Intrauterine Device 20 MCG/DAY Intrauterine",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50419042308",
      "ndc_label_name": "Mirena (52 MG) Intrauterine Device 20 MCG/DAY Intrauterine",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353053560",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440782560",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378351501",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090280000",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079008620",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440782590",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378351510",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378351593",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090101901",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107003105",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440782530",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919015390",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664049983",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079008601",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090101900",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904651961",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090214001",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096330",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107003134",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071048660",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629236601",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959077460",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090422200",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353053509",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090280001",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090214000",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096315",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084011911",
      "ndc_label_name": "Mirtazapine TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003130",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237000830",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629236701",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353053515",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407035010",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959077430",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407035030",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036915",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003190",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919015360",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028602",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096360",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664049918",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505024701",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959090130",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999062960",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085360",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788749201",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335066401",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505024708",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993060730",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919015330",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237000805",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993060704",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008000630",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162163900",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011515",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788749203",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047530",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003105",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739009810",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788749206",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071760",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084011901",
      "ndc_label_name": "Mirtazapine TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011530",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788749209",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003101",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012201",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011560",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335012205",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003103",
      "ndc_label_name": "Mirtazapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030501",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036960",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028601",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205048130",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047515",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047560",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071715",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012109",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162163903",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008000660",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030503",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085315",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030502",
      "ndc_label_name": "Mirtazapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037880",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440782660",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107000334",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378353001",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440782630",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096245",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378353005",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037845",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353053615",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096230",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353053660",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107000305",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440782690",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096253",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378353093",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037860",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353053671",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090105700",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096215",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090105503",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037815",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255800",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291095250",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353053609",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090105702",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090105803",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090105703",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090105802",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090297900",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255803",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037830",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353053653",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505024801",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079008720",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255802",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000390",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318103",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050083",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353053645",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090105800",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071068530",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335044104",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079008701",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267072430",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407035105",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000301",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237000905",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050018",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610052315",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335096401",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407035130",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993060830",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505024808",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010030",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237000930",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919015430",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610052330",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335096404",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187055430",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084012001",
      "ndc_label_name": "Mirtazapine TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739009910",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010045",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629236801",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084012011",
      "ndc_label_name": "Mirtazapine TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084653",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010015",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000305",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610052360",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000303",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010053",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335296301",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162164000",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862000330",
      "ndc_label_name": "Mirtazapine TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071345",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610052345",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071315",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993060804",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610052353",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189062630",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162164003",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084630",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162164005",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084645",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084615",
      "ndc_label_name": "Mirtazapine Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079008820",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378354505",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505024908",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237001005",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407035205",
      "ndc_label_name": "Mirtazapine Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378354501",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378354593",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107003205",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407035230",
      "ndc_label_name": "Mirtazapine Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237001030",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775403",
      "ndc_label_name": "Mirtazapine Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505024901",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050183",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378354570",
      "ndc_label_name": "Mirtazapine Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107003234",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079008801",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919015530",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050118",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775406",
      "ndc_label_name": "Mirtazapine Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993060930",
      "ndc_label_name": "Mirtazapine Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003205",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440782730",
      "ndc_label_name": "Mirtazapine Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993060904",
      "ndc_label_name": "Mirtazapine Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003201",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845909",
      "ndc_label_name": "Mirtazapine Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003203",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084012111",
      "ndc_label_name": "Mirtazapine TABLET 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084012101",
      "ndc_label_name": "Mirtazapine TABLET 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862003290",
      "ndc_label_name": "Mirtazapine TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845903",
      "ndc_label_name": "Mirtazapine Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775409",
      "ndc_label_name": "Mirtazapine Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788845906",
      "ndc_label_name": "Mirtazapine Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335133201",
      "ndc_label_name": "Mirtazapine Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135074560",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954044310",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386016006",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084004011",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069212",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069260",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069228",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135074562",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073511",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954044320",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069240",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386016012",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069230",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762500701",
      "ndc_label_name": "Misoprostol TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073501",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762500702",
      "ndc_label_name": "Misoprostol TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084004001",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789011108",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335963103",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789012108",
      "ndc_label_name": "miSOPROStol Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440782902",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440782904",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43393002304",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070720",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070704",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43393002404",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440782908",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070708",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43393020004",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070706",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030008",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43393002004",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070713",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069320",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135074660",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43393020048",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069340",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069312",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030020",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43393002204",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386016101",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069330",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070702",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43393020060",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687074611",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084004111",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789012804",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069360",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386016106",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762500802",
      "ndc_label_name": "Misoprostol TABLET 200 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069316",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268055560",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069328",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954044420",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084004101",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762500801",
      "ndc_label_name": "Misoprostol TABLET 200 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63704000801",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071046160",
      "ndc_label_name": "Misoprostol TABLET 200 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687074601",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954044410",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071046130",
      "ndc_label_name": "Misoprostol TABLET 200 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789012813",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071046190",
      "ndc_label_name": "Misoprostol TABLET 200 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030004",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804003710",
      "ndc_label_name": "miSOPROStol Tablet 200 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904679104",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155060403",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043016003",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268057011",
      "ndc_label_name": "Modafinil TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407092830",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043016001",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155060409",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268057012",
      "ndc_label_name": "Modafinil TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332038530",
      "ndc_label_name": "Modafinil TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090247200",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629739401",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060101",
      "ndc_label_name": "Modafinil TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505252601",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55253080130",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505252603",
      "ndc_label_name": "Modafinil TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407096030",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060130",
      "ndc_label_name": "Modafinil TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629739402",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205047730",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55253080190",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578000506",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237015430",
      "ndc_label_name": "Modafinil TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332038590",
      "ndc_label_name": "Modafinil TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237015490",
      "ndc_label_name": "Modafinil TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578000516",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452034213",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084062111",
      "ndc_label_name": "Modafinil TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084062121",
      "ndc_label_name": "Modafinil TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097653",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335112201",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097630",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097660",
      "ndc_label_name": "Modafinil Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353092530",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904679204",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353092553",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090247300",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155060509",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291060030",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155086203",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155060503",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060201",
      "ndc_label_name": "Modafinil TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043016103",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095653",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268057112",
      "ndc_label_name": "Modafinil TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083130",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268057111",
      "ndc_label_name": "Modafinil TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043016101",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155086209",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060230",
      "ndc_label_name": "Modafinil TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095630",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407096130",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237015590",
      "ndc_label_name": "Modafinil TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788807909",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332038690",
      "ndc_label_name": "Modafinil TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043016190",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083153",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828003",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452034313",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55253080290",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084072111",
      "ndc_label_name": "Modafinil TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828009",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084072121",
      "ndc_label_name": "Modafinil TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55253080230",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505252701",
      "ndc_label_name": "Modafinil TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087353",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335140201",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237015530",
      "ndc_label_name": "Modafinil TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788807903",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098930",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788807906",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865303",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332038630",
      "ndc_label_name": "Modafinil TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578000606",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578000616",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505252703",
      "ndc_label_name": "Modafinil TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788828006",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098953",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865306",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335225806",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205054430",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098960",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087380",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865309",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087330",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068553",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578000601",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452034319",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804012630",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335225801",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087360",
      "ndc_label_name": "Modafinil Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10119002003",
      "ndc_label_name": "Moisture Eyes SOLUTION 1-0.3 % OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00713072637",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063437",
      "ndc_label_name": "Mometasone Furoate CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217900",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063415",
      "ndc_label_name": "Mometasone Furoate CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335287301",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714097402",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802025742",
      "ndc_label_name": "Mometasone Furoate CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714097401",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802025735",
      "ndc_label_name": "Mometasone Furoate CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462019217",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090299100",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713072615",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629868101",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090102500",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002083263",
      "ndc_label_name": "Mometasone Furoate CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462019255",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162140404",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959085945",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407504",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629868201",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834504",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854804",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162140402",
      "ndc_label_name": "Mometasone Furoate Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713072715",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168027146",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063515",
      "ndc_label_name": "Mometasone Furoate OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713063537",
      "ndc_label_name": "Mometasone Furoate OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668052701",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629930601",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802011937",
      "ndc_label_name": "Mometasone Furoate OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168027115",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802011942",
      "ndc_label_name": "Mometasone Furoate OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462022555",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162139304",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713072737",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462022517",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205041315",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835704",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668052704",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162139302",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090102600",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090163300",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629868401",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002004063",
      "ndc_label_name": "Mometasone Furoate OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629930501",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629868301",
      "ndc_label_name": "Mometasone Furoate Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071132805",
      "ndc_label_name": "Mometasone Furoate OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802011846",
      "ndc_label_name": "Mometasone Furoate SOLUTION 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713070185",
      "ndc_label_name": "Mometasone Furoate Solution 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130503",
      "ndc_label_name": "Mometasone Furoate SOLUTION 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922007201",
      "ndc_label_name": "Mometasone Furoate Solution 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802011859",
      "ndc_label_name": "Mometasone Furoate SOLUTION 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168027230",
      "ndc_label_name": "Mometasone Furoate Solution 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629868601",
      "ndc_label_name": "Mometasone Furoate Solution 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162139203",
      "ndc_label_name": "Mometasone Furoate Solution 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629868501",
      "ndc_label_name": "Mometasone Furoate Solution 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162139206",
      "ndc_label_name": "Mometasone Furoate Solution 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672130504",
      "ndc_label_name": "Mometasone Furoate SOLUTION 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168027260",
      "ndc_label_name": "Mometasone Furoate Solution 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462038502",
      "ndc_label_name": "Mometasone Furoate Solution 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922007221",
      "ndc_label_name": "Mometasone Furoate Solution 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462038537",
      "ndc_label_name": "Mometasone Furoate Solution 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08881580123",
      "ndc_label_name": "Monoject Flush Syr/Hep Lock SOLUTION 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881590121",
      "ndc_label_name": "Monoject Flush Syr/Hep Lock SOLUTION 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881570123",
      "ndc_label_name": "Monoject Flush Syringe Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881570121",
      "ndc_label_name": "Monoject Flush Syringe Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881570125",
      "ndc_label_name": "Monoject Flush Syringe Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881570300",
      "ndc_label_name": "Monoject Flush Syringe Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881200086",
      "ndc_label_name": "Monoject Hypodermic Needle 18G X 1-1/2\"",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881250024",
      "ndc_label_name": "Monoject Hypodermic Needle 18G X 1-1/2\"",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080818113",
      "ndc_label_name": "Monoject Hypodermic Needle 18G X 1-1/2\"",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881200078",
      "ndc_label_name": "Monoject Hypodermic Needle 18G X 1-1/2\"",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881250016",
      "ndc_label_name": "Monoject Hypodermic Needle 18G X 1-1/2\"",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080818112",
      "ndc_label_name": "Monoject Hypodermic Needle 18G X 1-1/2\"",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881580121",
      "ndc_label_name": "Monoject PreFill Adv Heparin SOLUTION 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881590121",
      "ndc_label_name": "Monoject PreFill Adv Heparin SOLUTION 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17474012301",
      "ndc_label_name": "Monoject PreFill Heparin Sod SOLUTION 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17474012501",
      "ndc_label_name": "Monoject PreFill Heparin Sod SOLUTION 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881581125",
      "ndc_label_name": "Monoject PreFill SOLUTION 10 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881591125",
      "ndc_label_name": "Monoject PreFill SOLUTION 100 UNIT/ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881579123",
      "ndc_label_name": "Monoject Sodium Chloride Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881579125",
      "ndc_label_name": "Monoject Sodium Chloride Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881579300",
      "ndc_label_name": "Monoject Sodium Chloride Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080322100",
      "ndc_label_name": "Monoject Syringe 22G X 1\" 3 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08881513231",
      "ndc_label_name": "Monoject Syringe 22G X 1\" 3 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08080325100",
      "ndc_label_name": "Monoject Syringe 25G X 1\" 3 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881513538",
      "ndc_label_name": "Monoject Syringe 25G X 1\" 3 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08080300555",
      "ndc_label_name": "Monoject Syringe Regular Tip 3 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881103025",
      "ndc_label_name": "Monoject Syringe Regular Tip 3 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571010010",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668008130",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904680861",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904680806",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668008190",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722072630",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729011910",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300022013",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729011915",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090610900",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300022010",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668008105",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237025530",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342010215",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062190",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722072610",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300022019",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343003730",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342010210",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571010009",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000990",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090248000",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217601",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342010207",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722072690",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000930",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087909",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729011917",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071156103",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090610800",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090540300",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268055615",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090610801",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001036105",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353087930",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062110",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084087501",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268055611",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268057515",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237025590",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788943802",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645056054",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090217600",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063076230",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005130",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111072510",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111072530",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078114",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865017510",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809906",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090248001",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268057511",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111072590",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175021032",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343003799",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862057490",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175021043",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788943809",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111072594",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343003790",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001036104",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809909",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175021046",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788809903",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084087511",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934020230",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078130",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001036103",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861706",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861003",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078190",
      "ndc_label_name": "Montelukast Sodium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788943801",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788943804",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002630",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861006",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861703",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367028705",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861009",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861709",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205018130",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012930",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610002660",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934020290",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367028709",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189041830",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788943803",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205018190",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056330",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865017590",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012909",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205077830",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865017530",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788943806",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189041890",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335051401",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009000910",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030630",
      "ndc_label_name": "Montelukast Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781555431",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668007930",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781555492",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766804",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668007905",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241001603",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063038130",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668007990",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241001609",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090136800",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342011010",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090223001",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722072730",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300022110",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111059390",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090292100",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300022113",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268057315",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090792000",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111059330",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090292101",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722072790",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237021290",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237021230",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300022119",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766803",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175020446",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766801",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135078130",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342011007",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187075130",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766802",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062230",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766806",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766809",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436009006",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187075190",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062210",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777109",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777106",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090136801",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062290",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056790",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063038121",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090792001",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090223000",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268057311",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777103",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175020432",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175020443",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777101",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777102",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777104",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205018930",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241001703",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722072830",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062330",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781555531",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781555592",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111059490",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668008005",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300022210",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090131300",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056890",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090470501",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668008090",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668008030",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766901",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722072890",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300022213",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261900",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022330",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012890",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241001709",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342011107",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062310",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261901",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300022219",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090470500",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090131301",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268057415",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062390",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342011110",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237021390",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135078230",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934048530",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268057411",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009730",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175020546",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766902",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111059430",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766909",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766904",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175020543",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237021330",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766903",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175020532",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766906",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187089630",
      "ndc_label_name": "Montelukast Sodium TABLET CHEWABLE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436009106",
      "ndc_label_name": "Montelukast Sodium Tablet Chewable 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808008202",
      "ndc_label_name": "Morphine Sulfate (Concentrate) SOLUTION 100 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054051750",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27808008201",
      "ndc_label_name": "Morphine Sulfate (Concentrate) SOLUTION 100 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406800312",
      "ndc_label_name": "Morphine Sulfate (Concentrate) SOLUTION 100 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527190636",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406800315",
      "ndc_label_name": "Morphine Sulfate (Concentrate) SOLUTION 100 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629230101",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054051741",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629230201",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406800324",
      "ndc_label_name": "Morphine Sulfate (Concentrate) SOLUTION 100 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75826013104",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054051744",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75826013115",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406800330",
      "ndc_label_name": "Morphine Sulfate (Concentrate) SOLUTION 100 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75826013101",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162128202",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162128203",
      "ndc_label_name": "Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00406839062",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304045201",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406839023",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862018801",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228432311",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858080401",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904656061",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959018990",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959018930",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629451401",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959018902",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071045756",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406839001",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959018960",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386054301",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162179103",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071045790",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629451404",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629451402",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162179109",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356052190",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071045784",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700036960",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162179106",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629451403",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382090601",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162179101",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071045760",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228427011",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406831523",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071028460",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858080101",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959018590",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700082460",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406831562",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406831501",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356083660",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904655761",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071028491",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959018530",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629108701",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919096660",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386054001",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267126800",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959018502",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304045001",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084015701",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629448305",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162178901",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629448302",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862018501",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071028490",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629448301",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629448304",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382090301",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162178903",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162178906",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071028430",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959018560",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335073601",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700082490",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162178909",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919096630",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629448303",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084015711",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904655861",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040660",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406833001",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386054101",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406833062",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862018601",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629397901",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228427111",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858080201",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700082530",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356083890",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040602",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040690",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700082590",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629448403",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406833023",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919092330",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629448402",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629397903",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040630",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629397902",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162179001",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629448405",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700082560",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629448406",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629448404",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084015811",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919092360",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267126900",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629448407",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382090401",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629448401",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071028584",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071028560",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335067603",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304045101",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162179006",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071028591",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071028590",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071028530",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084015801",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335067601",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335067602",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071028556",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162179003",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162179009",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406838001",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904655961",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406838023",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228431111",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071048460",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071048491",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356083330",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356083360",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406838062",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386054201",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862018701",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858080301",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071048490",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071048430",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071017904",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040960",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382090501",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162179301",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335070706",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040930",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162179303",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304075801",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162179306",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071048456",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267127000",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162179309",
      "ndc_label_name": "Morphine Sulfate ER Tablet Extended Release 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687076086",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121090405",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121495594",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687092786",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054023749",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687092740",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687076040",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121495505",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054023763",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559017001",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121090494",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094000159",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559017005",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094000162",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75826012905",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75826012917",
      "ndc_label_name": "Morphine Sulfate Solution 10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75826013005",
      "ndc_label_name": "Morphine Sulfate Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054023863",
      "ndc_label_name": "Morphine Sulfate Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054023849",
      "ndc_label_name": "Morphine Sulfate Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75826013017",
      "ndc_label_name": "Morphine Sulfate Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00832027311",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629417502",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406511801",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999084830",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054023525",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406511823",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054023524",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999084860",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013860",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862061501",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013890",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629417501",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071017706",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061701",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406511862",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071017704",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071035291",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071035260",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629417503",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071035284",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061711",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267127600",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629845901",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071035230",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877067001",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071035256",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071035290",
      "ndc_label_name": "Morphine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054023625",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959018290",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862061701",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054023624",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406511923",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406511962",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629378902",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832027411",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959018230",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071017804",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090560",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406511901",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919041330",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999084930",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071049030",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090530",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629378901",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071017806",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959018260",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959018202",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071049060",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629378903",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877067101",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629846001",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071049090",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267127700",
      "ndc_label_name": "Morphine Sulfate Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00363040421",
      "ndc_label_name": "Motion Sickness Relief TABLET CHEWABLE 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00832141003",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090309100",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090635700",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781713593",
      "ndc_label_name": "Moxifloxacin HCl SOLUTION 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478051919",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714064301",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180042201",
      "ndc_label_name": "Moxifloxacin HCl SOLUTION 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378543035",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090478100",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505058204",
      "ndc_label_name": "Moxifloxacin HCl SOLUTION 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756063825",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090624800",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919055305",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407032103",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189007605",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069008101",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862084003",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332050503",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425023901",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72266015801",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804005503",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162210702",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425037901",
      "ndc_label_name": "Moxifloxacin HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668020130",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090314701",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904740704",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090144200",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090724401",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904640604",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904640606",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093738756",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205000105",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268057613",
      "ndc_label_name": "Moxifloxacin HCl TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090766500",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090405801",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003710",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991094333",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429089330",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904740706",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205000130",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111011230",
      "ndc_label_name": "Moxifloxacin HCl TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789008010",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090410000",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862060330",
      "ndc_label_name": "Moxifloxacin HCl TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084072211",
      "ndc_label_name": "Moxifloxacin HCl TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789035010",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090660901",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084072265",
      "ndc_label_name": "Moxifloxacin HCl TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090659501",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789023310",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268057611",
      "ndc_label_name": "Moxifloxacin HCl TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090660900",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73473090330",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237015630",
      "ndc_label_name": "Moxifloxacin HCl TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789003810",
      "ndc_label_name": "Moxifloxacin HCl Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63824025612",
      "ndc_label_name": "Mucinex Cough For Kids Packet 5-100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927835800",
      "ndc_label_name": "Mucosal Atomization Device",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58602071467",
      "ndc_label_name": "Mucus Relief DM Tablet Extended Release 12 Hour 30-600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000072201",
      "ndc_label_name": "Mucus Relief DM Tablet Extended Release 12 Hour 30-600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917004112",
      "ndc_label_name": "Mucus Relief DM Tablet Extended Release 12 Hour 30-600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536116137",
      "ndc_label_name": "Mucus Relief DM Tablet Extended Release 12 Hour 30-600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536116134",
      "ndc_label_name": "Mucus Relief DM Tablet Extended Release 12 Hour 30-600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536144634",
      "ndc_label_name": "Mucus Relief DM Tablet Extended Release 12 Hour 30-600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000049101",
      "ndc_label_name": "Mucus Relief DM Tablet Extended Release 12 Hour 30-600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162227303",
      "ndc_label_name": "Multi-Vit-Flor Tablet Chewable 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42494043330",
      "ndc_label_name": "Multi-Vit-Flor Tablet Chewable 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657032750",
      "ndc_label_name": "Multi-Vitamin/Fluoride/Iron Solution 0.25-10 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289086801",
      "ndc_label_name": "Multiple Vitamins-Iron Tablet Chewable 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295013939",
      "ndc_label_name": "Multivitamin Plus Iron Adult Tablet Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "62542020030",
      "ndc_label_name": "Multivitamin w/Fluoride Tablet Chewable 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826016910",
      "ndc_label_name": "Multivitamin w/Fluoride Tablet Chewable 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81542074050",
      "ndc_label_name": "Multivitamin/Fluoride Solution 0.25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61269016150",
      "ndc_label_name": "Multivitamin/Fluoride Solution 0.25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61269016250",
      "ndc_label_name": "Multivitamin/Fluoride Solution 0.5 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81542074150",
      "ndc_label_name": "Multivitamin/Fluoride Solution 0.5 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58657016401",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162165601",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42937070910",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162165609",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657016490",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61269015601",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629113701",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629113601",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59088010859",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657016501",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42937071010",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090447500",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657016590",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629113901",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629113801",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61269015701",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162165709",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59088010959",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162165701",
      "ndc_label_name": "Multivitamin/Fluoride Tablet Chewable 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090089800",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090192900",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922002804",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904728454",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999064422",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121107650",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121107601",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093101042",
      "ndc_label_name": "Mupirocin OINTMENT 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919015822",
      "ndc_label_name": "Mupirocin OINTMENT 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268056811",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922002825",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002098599",
      "ndc_label_name": "Mupirocin OINTMENT 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436011201",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168035222",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904728469",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922007325",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629868701",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187026122",
      "ndc_label_name": "Mupirocin OINTMENT 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802011222",
      "ndc_label_name": "Mupirocin OINTMENT 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462018022",
      "ndc_label_name": "Mupirocin OINTMENT 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118003202",
      "ndc_label_name": "Mupirocin OINTMENT 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922007304",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760096022",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802011214",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799302",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853402",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090158700",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033003299",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919040722",
      "ndc_label_name": "Mupirocin OINTMENT 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959074322",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425024601",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436018001",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187001522",
      "ndc_label_name": "Mupirocin OINTMENT 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70166035510",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268056815",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436101001",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012822",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187052522",
      "ndc_label_name": "Mupirocin OINTMENT 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131200",
      "ndc_label_name": "Mupirocin OINTMENT 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020322",
      "ndc_label_name": "Mupirocin OINTMENT 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672131201",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033002050",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187015122",
      "ndc_label_name": "Mupirocin OINTMENT 2 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864202",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033002099",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518180800",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335282901",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033003250",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162227002",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425025401",
      "ndc_label_name": "Mupirocin Ointment 2 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58204000404",
      "ndc_label_name": "MVW Complete Formulation Solution Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60429005905",
      "ndc_label_name": "Mycophenolate Mofetil CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093733401",
      "ndc_label_name": "Mycophenolate Mofetil CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054016329",
      "ndc_label_name": "Mycophenolate Mofetil CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054016325",
      "ndc_label_name": "Mycophenolate Mofetil CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781206701",
      "ndc_label_name": "Mycophenolate Mofetil CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093733405",
      "ndc_label_name": "Mycophenolate Mofetil CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722087805",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904707461",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888019205",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378225001",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781206705",
      "ndc_label_name": "Mycophenolate Mofetil CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378225005",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904746661",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079072101",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079072120",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729009416",
      "ndc_label_name": "Mycophenolate Mofetil CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73190000901",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722087801",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651062405",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781206789",
      "ndc_label_name": "Mycophenolate Mofetil CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155083001",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429005901",
      "ndc_label_name": "Mycophenolate Mofetil CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877026605",
      "ndc_label_name": "Mycophenolate Mofetil CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155083005",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268055711",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268055715",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049411",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729009401",
      "ndc_label_name": "Mycophenolate Mofetil CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380072606",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049401",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70748018602",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543098807",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380072607",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651062401",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687088511",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687088501",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877026601",
      "ndc_label_name": "Mycophenolate Mofetil CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888019201",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70748018601",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73190000950",
      "ndc_label_name": "Mycophenolate Mofetil Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42658010107",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429007005",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090427500",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054016625",
      "ndc_label_name": "Mycophenolate Mofetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480357105",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781517501",
      "ndc_label_name": "Mycophenolate Mofetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054016629",
      "ndc_label_name": "Mycophenolate Mofetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378447205",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651063805",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70748026202",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079037901",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378447201",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155083605",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219213501",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781517505",
      "ndc_label_name": "Mycophenolate Mofetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729001916",
      "ndc_label_name": "Mycophenolate Mofetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429007001",
      "ndc_label_name": "Mycophenolate Mofetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888018501",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877022501",
      "ndc_label_name": "Mycophenolate Mofetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480357101",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268055815",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003392",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729001901",
      "ndc_label_name": "Mycophenolate Mofetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380072506",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043801",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904707861",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003380",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380072507",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079037920",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155083601",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722087901",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003398",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003375",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722087905",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003394",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543098907",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219213505",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42658010105",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651063801",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268055811",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888018505",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687043811",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70748026201",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003370",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877022505",
      "ndc_label_name": "Mycophenolate Mofetil TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003360",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73190001050",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804003330",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003353",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610003390",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73190001001",
      "ndc_label_name": "Mycophenolate Mofetil Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228046505",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185014501",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584392",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584390",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185014505",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584305",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584381",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584360",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065042",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436604601",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584395",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090153104",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584330",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097220",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584391",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440784360",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700084560",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919060960",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440784391",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090153107",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584393",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097230",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591367005",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090074708",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760038615",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919066830",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591367001",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065000",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090074704",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090074700",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228046501",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090153100",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919015990",
      "ndc_label_name": "Nabumetone TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919066890",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436604602",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065060",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090074707",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090074705",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065040",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090529408",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919066860",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135014560",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065028",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036860",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065014",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090153105",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002069600",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065020",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629850601",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097096507",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065030",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267048260",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002069610",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090343300",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700084530",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036815",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267048290",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205003030",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065090",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776502",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002069640",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090529400",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760038660",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919015960",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776501",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335123402",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002069620",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097096512",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063021",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090529407",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629850801",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919062660",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776506",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162155705",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187048414",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367024105",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760001515",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002069630",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097760",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267048220",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954078420",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189018430",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187048430",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954078410",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760001560",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063011",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335229201",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462035801",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021014",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282025701",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267048230",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189018414",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267048240",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267101500",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776503",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367024101",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005401",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021010",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776508",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021007",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180014101",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097730",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788776509",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097700",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097772",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005301",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205003020",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021020",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335139103",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335078103",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162155701",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097755",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282025705",
      "ndc_label_name": "Nabumetone TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335123403",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021030",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097790",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021060",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189018490",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005402",
      "ndc_label_name": "Nabumetone Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584490",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584405",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085940",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097330",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591367105",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584460",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185014601",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584430",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634090571",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634090560",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080003",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090616702",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090150002",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440784491",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185014605",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584481",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090538603",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065602",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080004",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228046601",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065620",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090150003",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584492",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440584491",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228046605",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919069830",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090150000",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065628",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002127104",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090538600",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090538602",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440784460",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135014660",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759709",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090538604",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065630",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289060920",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090616703",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065600",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591367101",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267052960",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097096607",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090616700",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700084060",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289060940",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090616704",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065640",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080000",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759706",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097890",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065690",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919055160",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289060960",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065642",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065660",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080002",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759708",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189007260",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002127103",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759701",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036960",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002127102",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036990",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090150004",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335229301",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010402",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289060930",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004030",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919016060",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268206",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267052930",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760036914",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010403",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759702",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700084030",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760038760",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187030730",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367024205",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267052940",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919069860",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037830",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954078510",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760038714",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268203",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268202",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954078520",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788759703",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268205",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268204",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097860",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760038790",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629851001",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629850901",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789054014",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097096612",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335075401",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180014201",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335155901",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919016030",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162155801",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097855",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010401",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367024201",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335075403",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629268201",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282025805",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205037830",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267052920",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097830",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205053030",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097872",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205097800",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282025801",
      "ndc_label_name": "Nabumetone TABLET 750 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335075402",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162155805",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189007230",
      "ndc_label_name": "Nabumetone Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687030295",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781800401",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378002801",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904707007",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762081001",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687030225",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904707061",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781800492",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001031700",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155073001",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781800410",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651058901",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001069000",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687088711",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687088721",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722034701",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72664021101",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162223401",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135068601",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079081220",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382073201",
      "ndc_label_name": "Nadolol TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332040231",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079081201",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097086707",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385013301",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001063000",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407097701",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238112309",
      "ndc_label_name": "Nadolol TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282034701",
      "ndc_label_name": "Nadolol Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781800501",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687089821",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407097801",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378117101",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722034801",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904707161",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378117110",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904707107",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687089811",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001063100",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651025101",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781800592",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079081301",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135068701",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762081101",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687031395",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238112409",
      "ndc_label_name": "Nadolol TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001069100",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001031800",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155073101",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687031325",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097086807",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332040331",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079081320",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162223301",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385013401",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72664021201",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382073301",
      "ndc_label_name": "Nadolol TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282034801",
      "ndc_label_name": "Nadolol Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407097901",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155073201",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378113210",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999020230",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781800601",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378113201",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135068801",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001031900",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72664021301",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651025201",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722034901",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382073401",
      "ndc_label_name": "Nadolol TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781800692",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762081201",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001063200",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238112509",
      "ndc_label_name": "Nadolol TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282034901",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385013501",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332040431",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097086907",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001069200",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162219801",
      "ndc_label_name": "Nadolol Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590800",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781717612",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11917004033",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802057884",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00480347868",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00093216568",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480347819",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00093216519",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090696300",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "42291049302",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802057824",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60219210407",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "42291049301",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629932101",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781717606",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008000701",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425040901",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68001064545",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "55700098501",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162237602",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802057800",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802081100",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090671000",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802081184",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238210401",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80425025901",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238210407",
      "ndc_label_name": "Naloxone HCl Liquid 4 MG/0.1ML Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "42023022401",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641620501",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150034510",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066014210",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329146901",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066014201",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641620510",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075058",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075011",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598075010",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457099202",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045011201",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329336901",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76045011220",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76329346901",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150034501",
      "ndc_label_name": "Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629104601",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904703604",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224020650",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406117001",
      "ndc_label_name": "Naltrexone HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406117003",
      "ndc_label_name": "Naltrexone HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090682000",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291063230",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155088601",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335241907",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729008101",
      "ndc_label_name": "Naltrexone HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850030030",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090307600",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729008110",
      "ndc_label_name": "Naltrexone HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407095901",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335032688",
      "ndc_label_name": "Naltrexone HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090286600",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155088603",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335032683",
      "ndc_label_name": "Naltrexone HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084029121",
      "ndc_label_name": "Naltrexone HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090492500",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291063260",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094090930",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135024230",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629104701",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135024290",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407095930",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091931",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224020630",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084029111",
      "ndc_label_name": "Naltrexone HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708460",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094085361",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850030001",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094085366",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135024260",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162215403",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094085359",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162156601",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335274301",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335248101",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094090950",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162156603",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094085362",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162231103",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335248001",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162231101",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335301201",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335301101",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335304001",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096431",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804019930",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335303901",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162252901",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162252903",
      "ndc_label_name": "Naltrexone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69230030580",
      "ndc_label_name": "Naproxen Sodium Capsule 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69230030520",
      "ndc_label_name": "Naproxen Sodium Capsule 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917012211",
      "ndc_label_name": "Naproxen Sodium CAPSULE 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090068502",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802049075",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090068505",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056436",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43063090920",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250047771",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802049071",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056368",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51824003001",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090335600",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959046915",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483060905",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43063090930",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49483060901",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802049078",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090335601",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959046920",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090336900",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959046960",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959046940",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289057920",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090068500",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55289057930",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959046924",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896095401",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51824007201",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187098630",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61919038830",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504001292",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090068501",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187079420",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959046930",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187098624",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959046928",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788898701",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61919038840",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788844703",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187098628",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230032924",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896095405",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788844304",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187059628",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189027240",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187059630",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335128202",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788844302",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335128207",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187059610",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189000330",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267034328",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789054314",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504011104",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789054328",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788844704",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187059624",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788844303",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267034320",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788844706",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504001492",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788844306",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788844702",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788898708",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230032901",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230032902",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788898709",
      "ndc_label_name": "Naproxen Sodium TABLET 220 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230032910",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230032905",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205059530",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230032950",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205059524",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189000314",
      "ndc_label_name": "Naproxen Sodium Tablet 220 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00054363063",
      "ndc_label_name": "Naproxen Suspension 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68134020116",
      "ndc_label_name": "Naproxen Suspension 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192061916",
      "ndc_label_name": "Naproxen Suspension 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722068205",
      "ndc_label_name": "Naproxen Suspension 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238173002",
      "ndc_label_name": "Naproxen Suspension 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954015110",
      "ndc_label_name": "Naproxen Suspension 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71297020016",
      "ndc_label_name": "Naproxen Suspension 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785006",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785085",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785060",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353021680",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785010",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060006",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785030",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353021660",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785020",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785091",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353021653",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268059411",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785081",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060020",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060015",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268059415",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785092",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353021694",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353021670",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032420",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060060",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353050680",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060030",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019030",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353050660",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353050653",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090278804",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019090",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483061950",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228043401",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353050670",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032430",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353050694",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090475204",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079079320",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032440",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019028",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052001",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228043405",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032460",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483061901",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079079301",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019020",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052099",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462018805",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015140",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032415",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015120",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999047330",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187046130",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019060",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150013816",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999047360",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010013705",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629851101",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059280",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019040",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162018810",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162018850",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335186901",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015160",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462018801",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052005",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282034001",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335186902",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150013815",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150013814",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771043405",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059253",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282034005",
      "ndc_label_name": "Naproxen TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010013701",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804022930",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771043401",
      "ndc_label_name": "Naproxen Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785106",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785103",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090463701",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785192",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785110",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065060",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065042",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065021",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785120",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785130",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268059511",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065015",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065014",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090158302",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353021853",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065030",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785160",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065006",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462018901",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079079420",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065024",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090463600",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353021880",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483061750",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065010",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919016260",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794601",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629851201",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483061701",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019110",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090158308",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019115",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065020",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162018910",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788990603",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052101",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090158304",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019128",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090158401",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002031000",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079079401",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162018950",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788990606",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884401",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090463802",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019140",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090158500",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002031010",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019102",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794603",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150013916",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335038606",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090463808",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019142",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090463804",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760014020",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019114",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794606",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025501",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771102",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228043505",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629851301",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228043501",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771103",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019130",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010013801",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059180",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794609",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019120",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052105",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268059515",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025502",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019160",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335038608",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019100",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335038602",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544045653",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544045680",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700098730",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335038605",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002031015",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059153",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760064420",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185005",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771108",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884409",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919016230",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185006",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002031020",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009506",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052199",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282034105",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794602",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462018905",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002031030",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771101",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884403",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771106",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760064460",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884402",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884406",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335038601",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015240",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335038603",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788884408",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042530",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788771109",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282034101",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010013805",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771043501",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794608",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004801",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335038607",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017502",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150013914",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042560",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150013915",
      "ndc_label_name": "Naproxen TABLET 375 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771043505",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335038604",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425001001",
      "ndc_label_name": "Naproxen Tablet 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785214",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440185260",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785230",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785285",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440185460",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785206",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785291",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785220",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634068460",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785210",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092060",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356068415",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785204",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785290",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785292",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785260",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353067753",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353021153",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483061850",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062818",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440785281",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063034406",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063034404",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062820",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666601",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353067780",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090047800",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092090",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634068471",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092006",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092004",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062860",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666604",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999000945",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090047806",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353021170",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092014",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092015",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090304102",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092020",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666702",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090047804",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048000",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666606",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092028",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063092030",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666602",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063093720",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436091004",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048100",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048104",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666701",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49483061801",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353021160",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666605",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353021180",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436660901",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048300",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090303604",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228043601",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090047807",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090047801",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090719800",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090047802",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002031120",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090303606",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090303605",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436019002",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048106",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048102",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090767600",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048101",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002031130",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090564500",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090564501",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436061801",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048107",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048105",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436019001",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090304101",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289029810",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090564602",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090564504",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019302",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048109",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048202",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436061803",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305500",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289029824",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666600",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090564601",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019314",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048201",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090303602",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436660903",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090564505",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289029828",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090676200",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666609",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019321",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090303600",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090303607",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019324",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090698000",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700088860",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436019004",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436091001",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019328",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090303601",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090564502",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019335",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436660906",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760056130",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436061802",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436091002",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019342",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090564506",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090564507",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002031114",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079079501",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020460",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289029820",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079079520",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019360",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228043605",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090564509",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289029814",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019330",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037628",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289029830",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019340",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019390",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655062152",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666607",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289029890",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289029806",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037630",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289029840",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049111",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002031160",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019310",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019300",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289029893",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289029860",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919058645",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118019009",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017360",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289029815",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760056114",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019315",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700088830",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700031690",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919058660",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760056460",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020414",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700088820",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760056160",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019320",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020430",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760056115",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002820",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037645",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037614",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760056414",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760056430",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289029807",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147703",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760056420",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147702",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919058690",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037620",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020420",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002810",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700031620",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147706",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020428",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147705",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002840",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002814",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020490",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002860",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700031630",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629851501",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037690",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629586301",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147701",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147710",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037660",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015314",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700088890",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739040310",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002815",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015310",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162019011",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629851401",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919058620",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015360",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049101",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015330",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002890",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015342",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462019050",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162019010",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919058630",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788709009",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760056415",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015340",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187045560",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071400603",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879702",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047570",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147704",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860202",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017330",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047553",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162019050",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788709002",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205059714",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788709006",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629147707",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860207",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919058614",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788709001",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052205",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788709005",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335034505",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879703",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052201",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879701",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002830",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788709004",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015320",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860209",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048953",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788990706",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015315",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879707",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187045520",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860205",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047530",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788990703",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059753",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69512019010",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015390",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150014014",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187045530",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860208",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462019001",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010013910",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189013630",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934074630",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462019005",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934007320",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015391",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010013901",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462019030",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934012430",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032115",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205059715",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788709003",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934012460",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047580",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518382201",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788709007",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934080330",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032130",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335034506",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860201",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934074690",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788709008",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205059720",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879704",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205059710",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004201",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335248507",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860204",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335034501",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860203",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043653",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788990702",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205059730",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004210",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032104",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860206",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335034504",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879705",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059770",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934007330",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335034509",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026402",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032120",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879708",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335248504",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879706",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059780",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335034502",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282034205",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026405",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004202",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150014015",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335277702",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788879709",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189013614",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335034507",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004290",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026414",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004230",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010013905",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043680",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150014016",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189013690",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335248501",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004903",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004901",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004902",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934074660",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056080",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335034503",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032160",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335248502",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189013671",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425004904",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509143603",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205059740",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026407",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335034508",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282034201",
      "ndc_label_name": "Naproxen TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043660",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026460",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005001",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509143606",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205059760",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509143609",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335248505",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004260",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048980",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026430",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056060",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771043601",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205059790",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425037801",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032190",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425037802",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610056053",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82461071160",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420004214",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335034500",
      "ndc_label_name": "Naproxen TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026490",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189013660",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005101",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189013620",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789054114",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026401",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005102",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026410",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771043605",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005002",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425037803",
      "ndc_label_name": "Naproxen Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42494045310",
      "ndc_label_name": "Naproxen Tablet Delayed Release 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093100505",
      "ndc_label_name": "Naproxen Tablet Delayed Release 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291062901",
      "ndc_label_name": "Naproxen Tablet Delayed Release 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093100501",
      "ndc_label_name": "Naproxen Tablet Delayed Release 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019430",
      "ndc_label_name": "Naproxen Tablet Delayed Release 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097085107",
      "ndc_label_name": "Naproxen Tablet Delayed Release 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954092510",
      "ndc_label_name": "Naproxen Tablet Delayed Release 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788707201",
      "ndc_label_name": "Naproxen Tablet Delayed Release 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289092128",
      "ndc_label_name": "Naproxen Tablet Delayed Release 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543042510",
      "ndc_label_name": "Naproxen Tablet Delayed Release 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205046960",
      "ndc_label_name": "Naproxen Tablet Delayed Release 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006060",
      "ndc_label_name": "Naproxen Tablet Delayed Release 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162227501",
      "ndc_label_name": "Naproxen Tablet Delayed Release 375 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090060801",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291063001",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051610",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440784930",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42494045410",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440784920",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440784960",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090302500",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090302503",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722033905",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090060901",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090060800",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051660",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090060803",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051614",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051640",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051602",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090302501",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051615",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051630",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051620",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051642",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162227601",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097085207",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267037360",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267037320",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543042610",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000360",
      "ndc_label_name": "Naproxen Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155005419",
      "ndc_label_name": "Naratriptan HCl TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054027803",
      "ndc_label_name": "Naratriptan HCl TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155005519",
      "ndc_label_name": "Naratriptan HCl TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043013100",
      "ndc_label_name": "Naratriptan HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452034172",
      "ndc_label_name": "Naratriptan HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043013109",
      "ndc_label_name": "Naratriptan HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054027903",
      "ndc_label_name": "Naratriptan HCl TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54859070912",
      "ndc_label_name": "Natalvit Tablet Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834020601",
      "ndc_label_name": "Nateglinide Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291063701",
      "ndc_label_name": "Nateglinide Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571075909",
      "ndc_label_name": "Nateglinide Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591335501",
      "ndc_label_name": "Nateglinide Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429043501",
      "ndc_label_name": "Nateglinide Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111032990",
      "ndc_label_name": "Nateglinide TABLET 120 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068411",
      "ndc_label_name": "Nateglinide Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884098501",
      "ndc_label_name": "Nateglinide Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084045921",
      "ndc_label_name": "Nateglinide Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016802",
      "ndc_label_name": "Nateglinide Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084045911",
      "ndc_label_name": "Nateglinide Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407065701",
      "ndc_label_name": "Nateglinide Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687068421",
      "ndc_label_name": "Nateglinide Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241000304",
      "ndc_label_name": "Nateglinide Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241000305",
      "ndc_label_name": "Nateglinide Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382072216",
      "ndc_label_name": "Nateglinide TABLET 120 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571075809",
      "ndc_label_name": "Nateglinide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291063601",
      "ndc_label_name": "Nateglinide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591335401",
      "ndc_label_name": "Nateglinide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084045811",
      "ndc_label_name": "Nateglinide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382072116",
      "ndc_label_name": "Nateglinide TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884098401",
      "ndc_label_name": "Nateglinide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407065601",
      "ndc_label_name": "Nateglinide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429043401",
      "ndc_label_name": "Nateglinide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016701",
      "ndc_label_name": "Nateglinide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084045821",
      "ndc_label_name": "Nateglinide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067321",
      "ndc_label_name": "Nateglinide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067311",
      "ndc_label_name": "Nateglinide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016702",
      "ndc_label_name": "Nateglinide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111032890",
      "ndc_label_name": "Nateglinide TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241000204",
      "ndc_label_name": "Nateglinide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834020501",
      "ndc_label_name": "Nateglinide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241000205",
      "ndc_label_name": "Nateglinide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00363036638",
      "ndc_label_name": "Natural Fiber POWDER 58.6 % ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487001223",
      "ndc_label_name": "Natural Psyllium Seed POWDER 100 % ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65504010028",
      "ndc_label_name": "Natural Vegetable Fiber Powder 48.57 % Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "07610017840",
      "ndc_label_name": "Natural Vitamin D-3 Tablet 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50474050015",
      "ndc_label_name": "Nayzilam Solution 5 MG/0.1ML Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50474050014",
      "ndc_label_name": "Nayzilam Solution 5 MG/0.1ML Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73796039150",
      "ndc_label_name": "Nebulizer Air Tube/Plugs",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73317570202",
      "ndc_label_name": "Nebulizer Mask Adult",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73317570201",
      "ndc_label_name": "Nebulizer Mask Child",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574414435",
      "ndc_label_name": "Neo-Polycin HC Ointment 1 % Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574425035",
      "ndc_label_name": "Neo-Polycin Ointment 3.5-400-10000 Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079001520",
      "ndc_label_name": "Neomycin Sulfate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73473090105",
      "ndc_label_name": "Neomycin Sulfate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822031007",
      "ndc_label_name": "Neomycin Sulfate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "39822031005",
      "ndc_label_name": "Neomycin Sulfate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383056510",
      "ndc_label_name": "Neomycin Sulfate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093117701",
      "ndc_label_name": "Neomycin Sulfate TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079001501",
      "ndc_label_name": "Neomycin Sulfate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135044390",
      "ndc_label_name": "Neomycin Sulfate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090057100",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth Ointment 3.5-10000-0.1 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208079535",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth OINTMENT 3.5-10000-0.1 OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090443500",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth Ointment 3.5-10000-0.1 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574416035",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth Ointment 3.5-10000-0.1 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999022035",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth Ointment 3.5-10000-0.1 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788874803",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth Ointment 3.5-10000-0.1 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187039535",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth OINTMENT 3.5-10000-0.1 OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090618100",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth Ointment 3.5-10000-0.1 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314063136",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth OINTMENT 3.5-10000-0.1 OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959040701",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth Ointment 3.5-10000-0.1 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189003835",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth Ointment 3.5-10000-0.1 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425022901",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth Ointment 3.5-10000-0.1 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205033035",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth Ointment 3.5-10000-0.1 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189053235",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth Ointment 3.5-10000-0.1 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788970205",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth SUSPENSION 0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919016705",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth SUSPENSION 0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69918051505",
      "ndc_label_name": "Neomycin-Polymyxin-Dexameth Suspension 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208079062",
      "ndc_label_name": "Neomycin-Polymyxin-Gramicidin Solution 1.75-10000-.025 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090024700",
      "ndc_label_name": "Neomycin-Polymyxin-Gramicidin Solution 1.75-10000-.025 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999059110",
      "ndc_label_name": "Neomycin-Polymyxin-Gramicidin Solution 1.75-10000-.025 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267095610",
      "ndc_label_name": "Neomycin-Polymyxin-Gramicidin Solution 1.75-10000-.025 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959025400",
      "ndc_label_name": "Neomycin-Polymyxin-Gramicidin Solution 1.75-10000-.025 Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208063110",
      "ndc_label_name": "Neomycin-Polymyxin-HC SOLUTION 1 % OTIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090043300",
      "ndc_label_name": "Neomycin-Polymyxin-HC Solution 1 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090236500",
      "ndc_label_name": "Neomycin-Polymyxin-HC Suspension 3.5-10000-1 Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788778701",
      "ndc_label_name": "Neomycin-Polymyxin-HC Suspension 3.5-10000-1 Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090043100",
      "ndc_label_name": "Neomycin-Polymyxin-HC Suspension 3.5-10000-1 Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090633600",
      "ndc_label_name": "Neomycin-Polymyxin-HC Suspension 3.5-10000-1 Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002090072",
      "ndc_label_name": "Neomycin-Polymyxin-HC SUSPENSION 3.5-10000-1 OTIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208063562",
      "ndc_label_name": "Neomycin-Polymyxin-HC SUSPENSION 3.5-10000-1 OTIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980044801",
      "ndc_label_name": "Neomycin-Polymyxin-HC Suspension 3.5-10000-1 Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919066210",
      "ndc_label_name": "Neomycin-Polymyxin-HC SUSPENSION 3.5-10000-1 OTIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314064511",
      "ndc_label_name": "Neomycin-Polymyxin-HC SUSPENSION 3.5-10000-1 OTIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959008400",
      "ndc_label_name": "Neomycin-Polymyxin-HC Suspension 3.5-10000-1 Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788992401",
      "ndc_label_name": "Neomycin-Polymyxin-HC SUSPENSION 3.5-10000-1 OTIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788813001",
      "ndc_label_name": "Neomycin-Polymyxin-HC Suspension 3.5-10000-1 Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629884401",
      "ndc_label_name": "Neomycin-Polymyxin-HC Suspension 3.5-10000-1 Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00536730001",
      "ndc_label_name": "Nephro-Vite Tablet 0.8 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536141501",
      "ndc_label_name": "Nephro-Vite Tablet 0.8 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65862093290",
      "ndc_label_name": "Nevirapine ER Tablet Extended Release 24 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862093330",
      "ndc_label_name": "Nevirapine ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378489093",
      "ndc_label_name": "Nevirapine ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781589331",
      "ndc_label_name": "Nevirapine ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342023807",
      "ndc_label_name": "Nevirapine ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005724",
      "ndc_label_name": "Nevirapine Suspension 50 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722050560",
      "ndc_label_name": "Nevirapine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61442047060",
      "ndc_label_name": "Nevirapine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378405091",
      "ndc_label_name": "Nevirapine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862002760",
      "ndc_label_name": "Nevirapine TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342000409",
      "ndc_label_name": "Nevirapine Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72426011803",
      "ndc_label_name": "Nexletol Tablet 180 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72426081803",
      "ndc_label_name": "Nexlizet Tablet 180-10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "74312005800",
      "ndc_label_name": "Niacin ER Capsule Extended Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768003993",
      "ndc_label_name": "Niacin ER Capsule Extended Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10006070020",
      "ndc_label_name": "Niacin ER Capsule Extended Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00761067720",
      "ndc_label_name": "Niacin ER Capsule Extended Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49483001401",
      "ndc_label_name": "Niacin ER Capsule Extended Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013919",
      "ndc_label_name": "Niacin ER Capsule Extended Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "35046000331",
      "ndc_label_name": "Niacin ER Capsule Extended Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00761004920",
      "ndc_label_name": "Niacin ER Capsule Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845010755",
      "ndc_label_name": "Niacin ER Capsule Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "35046000339",
      "ndc_label_name": "Niacin ER Capsule Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16563002902",
      "ndc_label_name": "Niacin ER Tablet Extended Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16563002901",
      "ndc_label_name": "Niacin ER Tablet Extended Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985022849",
      "ndc_label_name": "Niacin ER Tablet Extended Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604002782",
      "ndc_label_name": "Niacin ER Tablet Extended Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629070901",
      "ndc_label_name": "Niacin ER Tablet Extended Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055703",
      "ndc_label_name": "Niacin ER Tablet Extended Release 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681009000",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090081700",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768060748",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292022328",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610037680",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10006070010",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090081701",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013327",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610001060",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268058315",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268058311",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "47469004835",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985027474",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768029505",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090552700",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610001080",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629071403",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629071101",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58118441703",
      "ndc_label_name": "Niacin ER Tablet Extended Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536703301",
      "ndc_label_name": "Niacin ER Tablet Extended Release 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090144300",
      "ndc_label_name": "Niacin ER Tablet Extended Release 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604002636",
      "ndc_label_name": "Niacin Flush Free CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845014995",
      "ndc_label_name": "Niacin Flush Free CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312001661",
      "ndc_label_name": "Niacin Flush Free Capsule 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917010744",
      "ndc_label_name": "Niacin Flush Free CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768003787",
      "ndc_label_name": "Niacin Flush Free Capsule 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312001660",
      "ndc_label_name": "Niacin Flush Free Capsule 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40093010113",
      "ndc_label_name": "Niacin Flush Free CAPSULE 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312001976",
      "ndc_label_name": "Niacin Flush Free CAPSULE 500 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845005781",
      "ndc_label_name": "Niacin Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487000381",
      "ndc_label_name": "Niacin TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268058211",
      "ndc_label_name": "Niacin TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985021364",
      "ndc_label_name": "Niacin TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681005700",
      "ndc_label_name": "Niacin Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135018610",
      "ndc_label_name": "Niacin TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00761023920",
      "ndc_label_name": "Niacin TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135018601",
      "ndc_label_name": "Niacin TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10267001201",
      "ndc_label_name": "Niacin TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "35046000329",
      "ndc_label_name": "Niacin Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10267001204",
      "ndc_label_name": "Niacin TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917003930",
      "ndc_label_name": "Niacin TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268058215",
      "ndc_label_name": "Niacin TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312001480",
      "ndc_label_name": "Niacin Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629007101",
      "ndc_label_name": "Niacin Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "29135016801",
      "ndc_label_name": "Niacin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055740",
      "ndc_label_name": "Niacin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "48107002489",
      "ndc_label_name": "Niacin TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629071001",
      "ndc_label_name": "Niacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312000720",
      "ndc_label_name": "Niacin Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487001331",
      "ndc_label_name": "Niacin TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055539",
      "ndc_label_name": "Niacin TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629005101",
      "ndc_label_name": "Niacin TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055792",
      "ndc_label_name": "Niacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135019168",
      "ndc_label_name": "Niacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487003021",
      "ndc_label_name": "Niacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904227260",
      "ndc_label_name": "Niacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536407810",
      "ndc_label_name": "Niacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292012356",
      "ndc_label_name": "Niacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629071201",
      "ndc_label_name": "Niacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135019101",
      "ndc_label_name": "Niacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135019190",
      "ndc_label_name": "Niacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864079210",
      "ndc_label_name": "Niacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864079201",
      "ndc_label_name": "Niacin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135019110",
      "ndc_label_name": "Niacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135019160",
      "ndc_label_name": "Niacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "29135017001",
      "ndc_label_name": "Niacin TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845005801",
      "ndc_label_name": "Niacinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487001342",
      "ndc_label_name": "Niacinamide TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681001900",
      "ndc_label_name": "Niacinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54458065710",
      "ndc_label_name": "Niacinamide TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487001341",
      "ndc_label_name": "Niacinamide TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487001343",
      "ndc_label_name": "Niacinamide TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536589571",
      "ndc_label_name": "Nicotine Patch 24 Hour 14 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917001343",
      "ndc_label_name": "Nicotine Patch 24 Hour 14 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917003194",
      "ndc_label_name": "Nicotine Patch 24 Hour 14 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "35356059814",
      "ndc_label_name": "Nicotine Patch 24 Hour 14 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536589588",
      "ndc_label_name": "Nicotine Patch 24 Hour 14 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917001394",
      "ndc_label_name": "Nicotine Patch 24 Hour 14 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363089588",
      "ndc_label_name": "Nicotine Patch 24 Hour 14 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91899068474",
      "ndc_label_name": "Nicotine Patch 24 Hour 14 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11110035559",
      "ndc_label_name": "Nicotine Patch 24 Hour 14 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598044774",
      "ndc_label_name": "Nicotine Patch 24 Hour 14 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090114800",
      "ndc_label_name": "Nicotine Patch 24 Hour 14 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536589553",
      "ndc_label_name": "Nicotine Patch 24 Hour 14 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598044770",
      "ndc_label_name": "Nicotine Patch 24 Hour 14 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60429044414",
      "ndc_label_name": "Nicotine Patch 24 Hour 14 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917010902",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536589671",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "46122035374",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536589653",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363089653",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598044828",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090286000",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363089688",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91899068410",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917001339",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11110035557",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536589688",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917020883",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598044870",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "35356059914",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090283700",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60429044514",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090169700",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917001338",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598044874",
      "ndc_label_name": "Nicotine Patch 24 Hour 21 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536589488",
      "ndc_label_name": "Nicotine Patch 24 Hour 7 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598044670",
      "ndc_label_name": "Nicotine Patch 24 Hour 7 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00067488014",
      "ndc_label_name": "Nicotine Patch 24 Hour 7 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11110037083",
      "ndc_label_name": "Nicotine Patch 24 Hour 7 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "91899044074",
      "ndc_label_name": "Nicotine Patch 24 Hour 7 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60429044314",
      "ndc_label_name": "Nicotine Patch 24 Hour 7 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536589453",
      "ndc_label_name": "Nicotine Patch 24 Hour 7 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090169400",
      "ndc_label_name": "Nicotine Patch 24 Hour 7 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363089488",
      "ndc_label_name": "Nicotine Patch 24 Hour 7 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090638300",
      "ndc_label_name": "Nicotine Patch 24 Hour 7 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598044674",
      "ndc_label_name": "Nicotine Patch 24 Hour 7 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363036506",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536302923",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363045660",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536136223",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363042098",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363035260",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113020625",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363042849",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363045678",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536338601",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363412298",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250002996",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363042816",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363042062",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363035278",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363412262",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917016582",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015382",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250045678",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000034801",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536302906",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363048044",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536136206",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536302934",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250020629",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800002925",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802082725",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536311237",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917017924",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363412250",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536311201",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536340401",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800045678",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800020625",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57237032201",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142002925",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250045670",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536136234",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015383",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250036578",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802020625",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250020696",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000034802",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090356000",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57237032211",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917020875",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917020651",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57237032250",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63739037163",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000034701",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250045606",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000034601",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000034501",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800045660",
      "ndc_label_name": "Nicotine Polacrilex GUM 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63739037010",
      "ndc_label_name": "Nicotine Polacrilex Gum 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113042225",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363048349",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363053206",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363042198",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363042162",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363053260",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536137223",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363048316",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363048144",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363053278",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363053258",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363042949",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917017925",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536311301",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015378",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363048344",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363414950",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363060962",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536303006",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363414962",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090115100",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802065125",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142017025",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536311337",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536137234",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363060998",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536303023",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363414998",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63739036910",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536137206",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800053278",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142085478",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250044278",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536340501",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015380",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536338701",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000034101",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015381",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090667400",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250053206",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000034201",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015387",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250085478",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917022075",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000034402",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250042229",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57237032301",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250053270",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090498500",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250053278",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57237032311",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800017025",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63739036810",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090624000",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57237032350",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800053260",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000034301",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250017096",
      "ndc_label_name": "Nicotine Polacrilex GUM 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802000125",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090669500",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000034401",
      "ndc_label_name": "Nicotine Polacrilex Gum 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015396",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363034410",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363034423",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363020176",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363020105",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363034467",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113034405",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015400",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598048672",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598048681",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536133709",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363034408",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363034444",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536133735",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015398",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250073402",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917022062",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802008902",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800034403",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598048610",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800073402",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800034405",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015468",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802008901",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250020105",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090115200",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250034411",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598048627",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250034410",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162228702",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142034405",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802034403",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250070005",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802034405",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 2 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090706100",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250034405",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000056201",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000011701",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335272901",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598048624",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 2 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363087305",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363087323",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363087308",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363042405",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363042476",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250087305",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917022069",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536133835",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363087310",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250019005",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598048710",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536133809",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363087367",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802095701",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250087311",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015399",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015397",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250095702",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335273001",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800053905",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250042405",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598048724",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142087305",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250019003",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598048772",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802087303",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800095702",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800087305",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802095702",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162228802",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598048727",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598048781",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000055901",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "41250087310",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802087305",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090115400",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000056101",
      "ndc_label_name": "Nicotine Polacrilex Lozenge 4 MG Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "78742009146",
      "ndc_label_name": "Nicotine Polacrilex LOZENGE 4 MG MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959027310",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904722961",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440786008",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228249710",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348010712",
      "ndc_label_name": "NIFEdipine CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440786004",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999016128",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762100401",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289090708",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155019401",
      "ndc_label_name": "NIFEdipine CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959027308",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999016190",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959027340",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440786090",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079601",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079611",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289090779",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192061501",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267040110",
      "ndc_label_name": "NIFEdipine CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959027330",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429016301",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289090730",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315021101",
      "ndc_label_name": "NIFEdipine CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135073990",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021908",
      "ndc_label_name": "NIFEdipine Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228253010",
      "ndc_label_name": "NIFEdipine Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268060111",
      "ndc_label_name": "NIFEdipine Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268060115",
      "ndc_label_name": "NIFEdipine Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315021201",
      "ndc_label_name": "NIFEdipine CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959048830",
      "ndc_label_name": "NIFEdipine Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135074090",
      "ndc_label_name": "NIFEdipine Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155019501",
      "ndc_label_name": "NIFEdipine CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742026001",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090620300",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979001112",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904720861",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979001101",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090673200",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090620301",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904720806",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429004703",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175026037",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764203",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289079807",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090532802",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090673201",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268059715",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090620302",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059711",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175026046",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934060330",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187087590",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289079830",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268059711",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429004701",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090673202",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764201",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645051254",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162127709",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059701",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919031930",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742026003",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096372",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135052190",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764206",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682010810",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610029060",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059765",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096300",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096330",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096367",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175026043",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335049701",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682010830",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764209",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096396",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175026055",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335049702",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096360",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162127701",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877075701",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335049703",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096378",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048487",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877075758",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096390",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645060354",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096364",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162127703",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048401",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742026101",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090676700",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904708106",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090676701",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090184302",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090620102",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742026103",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979001001",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175026155",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090676702",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904708161",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268059815",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682010930",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135052290",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429004801",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268059811",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096400",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429004803",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979001012",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175026137",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816403",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877075801",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175026143",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760085990",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096467",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049490",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090184300",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059865",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816409",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682010910",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175026146",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645060454",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205041290",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335048902",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090620100",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096464",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096430",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934060430",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877075858",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096490",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096460",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096478",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059811",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096496",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335048901",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084059801",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335048904",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645051354",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048587",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096472",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816401",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335048903",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816406",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048501",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175026237",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904708206",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090415802",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904708204",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979000901",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979000912",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440786490",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090069900",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096572",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135052390",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084060321",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268059911",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090415800",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877075601",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090315200",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742026201",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335965103",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084060311",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742026203",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429004901",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090645000",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048601",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175026232",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175026246",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090645002",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096530",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096500",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096567",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268059915",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096590",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096564",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096596",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760086290",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877075658",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084060365",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096560",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096578",
      "ndc_label_name": "NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090424900",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353072360",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090303400",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090424901",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440786290",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407062201",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090424902",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353092960",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682010530",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353092930",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090528400",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682010510",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353092909",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068960",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651029501",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090528402",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090303401",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629910901",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090528401",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014416",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090303402",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162188702",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014430",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162253401",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014460",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742062001",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084160",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407062203",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959099660",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440786390",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013060",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090303502",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013030",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090303500",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959098260",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013080",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090423402",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090444200",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651029601",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353020930",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162226001",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742062101",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001209",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353020960",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001260",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090444202",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090423400",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682010610",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407062301",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407062303",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001216",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001204",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162253501",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682010630",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001230",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001280",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682010710",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407062401",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162253601",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742062201",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651029701",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162226101",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005516",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005560",
      "ndc_label_name": "NIFEdipine ER Tablet Extended Release 24 Hour 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440186620",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090031403",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386064201",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115164501",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440786606",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440786604",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040012",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040530",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440786614",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090569303",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090569302",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591368601",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040528",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440786640",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040014",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348080114",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440786620",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721703",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721702",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040040",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348080106",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904713661",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090730803",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919045820",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040002",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062411",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040508",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781030801",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348080128",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040010",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040516",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629145903",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040020",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040500",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687085011",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999021028",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919045802",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090031400",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118030801",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001038600",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721700",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040510",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187024528",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090031402",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919045814",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090730802",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687048301",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029720",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090730800",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040520",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205017114",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090569300",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084220",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062415",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015640",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040514",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348080140",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348080112",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027002",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040521",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629145902",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040515",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205037014",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040540",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629145906",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651079501",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789034014",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348080130",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205017128",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332039131",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013114",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700089314",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001060500",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629145901",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013128",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664023388",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603018401",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629145904",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027014",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687048311",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013120",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780600",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687085001",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629145905",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027010",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780601",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789034010",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382056001",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804024114",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756041211",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205037010",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205017110",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335221206",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205017120",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029714",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205037020",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591368501",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115164301",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001060400",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687083901",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115202310",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063067528",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348080228",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062315",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664023288",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904702661",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756041111",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687083911",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348080240",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062311",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002314",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651075301",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001038500",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063067540",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002330",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382055901",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687047201",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332039031",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205036514",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687047211",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386064101",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603018301",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781030701",
      "ndc_label_name": "Nitrofurantoin Macrocrystal Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440786806",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440786840",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440786820",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480347001",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185012210",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185012201",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440786802",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086501",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090373700",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811071910",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291057401",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086601",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714043901",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090373701",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904713761",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674802",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090676901",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746076206",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063058210",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090322300",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086500",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090385601",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781030301",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062515",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062511",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629919101",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086600",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666400",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674800",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289082214",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090086502",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002070410",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078300",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001042300",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666402",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090666401",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078330",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289082220",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090373702",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002070420",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078310",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825801",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090674801",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289082210",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063311",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700082214",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090459101",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289082202",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629174803",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085200",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675001",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760085314",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760019414",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205054614",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436659004",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063365",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004714",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019103",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078314",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099514",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099510",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023410",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959078320",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084044601",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019106",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335086303",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700082220",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001060600",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084044611",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335237706",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002070406",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857100",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181502",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181508",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746076201",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857101",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335237702",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024202",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002070414",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934012914",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603019601",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011520",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063301",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205054610",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335291401",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934026910",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289082206",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085220",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024210",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085214",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002110",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019107",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162126200",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019102",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700053214",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335086306",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038710",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019105",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862092901",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162126201",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181504",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335086301",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760047814",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017910",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181509",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335086302",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205054620",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017920",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002102",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017914",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205054630",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420019510",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919002114",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024206",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085255",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038606",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629246401",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038614",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335086307",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011514",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162047810",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008003214",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039514",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825800",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024214",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756040411",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934026914",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085210",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085230",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019101",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335019104",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335232002",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181503",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039510",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789038610",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011510",
      "ndc_label_name": "Nitrofurantoin Monohyd Macro Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386045011",
      "ndc_label_name": "Nitrofurantoin Suspension 25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571074024",
      "ndc_label_name": "Nitrofurantoin Suspension 25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603017601",
      "ndc_label_name": "Nitrofurantoin Suspension 25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472199208",
      "ndc_label_name": "Nitrofurantoin Suspension 25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980059324",
      "ndc_label_name": "Nitrofurantoin Suspension 25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651020623",
      "ndc_label_name": "Nitrofurantoin Suspension 25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377011831",
      "ndc_label_name": "Nitrofurantoin Suspension 25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70408023932",
      "ndc_label_name": "Nitrofurantoin Suspension 25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954049610",
      "ndc_label_name": "Nitrofurantoin Suspension 25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238251209",
      "ndc_label_name": "Nitrofurantoin Suspension 25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069082901",
      "ndc_label_name": "Nitrofurantoin Suspension 25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356004230",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.1 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378910293",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.1 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378910216",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.1 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598089630",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.1 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378910416",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.2 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382030901",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.2 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598089530",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.2 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378910493",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.2 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382030930",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.2 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378911216",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.4 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598089430",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.4 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378911293",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.4 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382031030",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.4 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382031001",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.4 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382031101",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.6 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378911616",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.6 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378911693",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.6 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598089330",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.6 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382031130",
      "ndc_label_name": "Nitroglycerin Patch 24 Hour 0.6 MG/HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629882801",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.3 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017301",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.3 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781045601",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.3 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547098510",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.3 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651065700",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.3 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888013801",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.3 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598043501",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.3 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429083901",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.3 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762492101",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.3 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756001311",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.3 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462063801",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.3 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547098610",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326600",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762330403",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.4 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547098604",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326601",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651065800",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651065804",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598043601",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.4 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598043635",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090681800",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017401",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781045701",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090487400",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429084004",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429084001",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598043611",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.4 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205048225",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017441",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756001402",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781045704",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090681801",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804012225",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462063901",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090487401",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888013932",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756001411",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205022525",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651065825",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629882901",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603026604",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462063925",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762330401",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.4 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462063945",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629883001",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804007725",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756001405",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017402",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603026601",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888013901",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888013933",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.4 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598043701",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.6 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429084101",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.6 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651065900",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.6 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762048901",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.6 MG SUBLINGUAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017501",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.6 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462064001",
      "ndc_label_name": "Nitroglycerin TABLET SUBLINGUAL 0.6 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781045801",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.6 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547098710",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.6 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756001611",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.6 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888014001",
      "ndc_label_name": "Nitroglycerin Tablet Sublingual 0.6 MG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591313760",
      "ndc_label_name": "Nizatidine Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806029960",
      "ndc_label_name": "Nizatidine Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959082430",
      "ndc_label_name": "Nizatidine Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959082460",
      "ndc_label_name": "Nizatidine Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60846030115",
      "ndc_label_name": "Nizatidine Solution 15 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68047018516",
      "ndc_label_name": "NoHist-LQ Liquid 4-10 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00378728385",
      "ndc_label_name": "Norethin Ace-Eth Estrad-FE Tablet 1-20 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378728353",
      "ndc_label_name": "Norethin Ace-Eth Estrad-FE Tablet 1-20 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378728885",
      "ndc_label_name": "Norethin Ace-Eth Estrad-FE Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378728853",
      "ndc_label_name": "Norethin Ace-Eth Estrad-FE Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090678200",
      "ndc_label_name": "Norethindrone Acet-Ethinyl Est Tablet 1-20 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378728085",
      "ndc_label_name": "Norethindrone Acet-Ethinyl Est Tablet 1-20 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378728053",
      "ndc_label_name": "Norethindrone Acet-Ethinyl Est Tablet 1-20 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462013279",
      "ndc_label_name": "Norethindrone Acet-Ethinyl Est TABLET 1-20 MG-MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462013281",
      "ndc_label_name": "Norethindrone Acet-Ethinyl Est TABLET 1-20 MG-MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378727453",
      "ndc_label_name": "Norethindrone Acet-Ethinyl Est Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378727485",
      "ndc_label_name": "Norethindrone Acet-Ethinyl Est Tablet 1.5-30 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378729189",
      "ndc_label_name": "Norethindrone Acetate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555021110",
      "ndc_label_name": "Norethindrone Acetate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291065090",
      "ndc_label_name": "Norethindrone Acetate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687092121",
      "ndc_label_name": "Norethindrone Acetate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742026750",
      "ndc_label_name": "Norethindrone Acetate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162047505",
      "ndc_label_name": "Norethindrone Acetate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462030450",
      "ndc_label_name": "Norethindrone Acetate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162047509",
      "ndc_label_name": "Norethindrone Acetate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407059950",
      "ndc_label_name": "Norethindrone Acetate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687092111",
      "ndc_label_name": "Norethindrone Acetate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090215000",
      "ndc_label_name": "Norethindrone Tablet 0.35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378727253",
      "ndc_label_name": "Norethindrone Tablet 0.35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378727285",
      "ndc_label_name": "Norethindrone Tablet 0.35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804017528",
      "ndc_label_name": "Norethindrone Tablet 0.35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378729253",
      "ndc_label_name": "Norethindrone TABLET 0.35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462030584",
      "ndc_label_name": "Norethindrone Tablet 0.35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378729285",
      "ndc_label_name": "Norethindrone Tablet 0.35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090616100",
      "ndc_label_name": "Norethindrone Tablet 0.35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180087673",
      "ndc_label_name": "Norethindrone Tablet 0.35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789043979",
      "ndc_label_name": "Norethindrone Tablet 0.35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180087671",
      "ndc_label_name": "Norethindrone Tablet 0.35 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187074828",
      "ndc_label_name": "Norethindrone TABLET 0.35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462030529",
      "ndc_label_name": "Norethindrone TABLET 0.35 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462065684",
      "ndc_label_name": "Norethindrone-Eth Estradiol Tablet 0.5-2.5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834012984",
      "ndc_label_name": "Norethindrone-Eth Estradiol TABLET 0.5-2.5 MG-MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462065629",
      "ndc_label_name": "Norethindrone-Eth Estradiol TABLET 0.5-2.5 MG-MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834012929",
      "ndc_label_name": "Norethindrone-Eth Estradiol TABLET 0.5-2.5 MG-MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090260300",
      "ndc_label_name": "Norgestim-Eth Estrad Triphasic Tablet 0.18/0.215/0.25 MG-35 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462056584",
      "ndc_label_name": "Norgestim-Eth Estrad Triphasic Tablet 0.18/0.215/0.25 MG-35 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291059084",
      "ndc_label_name": "Norgestim-Eth Estrad Triphasic Tablet 0.18/0.215/0.25 MG-35 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629235001",
      "ndc_label_name": "Norgestim-Eth Estrad Triphasic Tablet 0.18/0.215/0.25 MG-35 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291059028",
      "ndc_label_name": "Norgestim-Eth Estrad Triphasic Tablet 0.18/0.215/0.25 MG-35 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789402",
      "ndc_label_name": "Norgestim-Eth Estrad Triphasic Tablet 0.18/0.215/0.25 MG-35 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019128",
      "ndc_label_name": "Norgestim-Eth Estrad Triphasic Tablet 0.18/0.215/0.25 MG-35 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462056529",
      "ndc_label_name": "Norgestim-Eth Estrad Triphasic Tablet 0.18/0.215/0.25 MG-35 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180083873",
      "ndc_label_name": "Norgestim-Eth Estrad Triphasic Tablet 0.18/0.215/0.25 MG-35 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180083871",
      "ndc_label_name": "Norgestim-Eth Estrad Triphasic Tablet 0.18/0.215/0.25 MG-35 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205017028",
      "ndc_label_name": "Norgestim-Eth Estrad Triphasic Tablet 0.18/0.215/0.25 MG-35 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189052828",
      "ndc_label_name": "Norgestimate-Eth Estradiol Tablet 0.25-35 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629234901",
      "ndc_label_name": "Norgestimate-Eth Estradiol Tablet 0.25-35 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090225900",
      "ndc_label_name": "Norgestimate-Eth Estradiol Tablet 0.25-35 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291055328",
      "ndc_label_name": "Norgestimate-Eth Estradiol Tablet 0.25-35 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180084073",
      "ndc_label_name": "Norgestimate-Eth Estradiol Tablet 0.25-35 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180084071",
      "ndc_label_name": "Norgestimate-Eth Estradiol Tablet 0.25-35 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291055384",
      "ndc_label_name": "Norgestimate-Eth Estradiol Tablet 0.25-35 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090339401",
      "ndc_label_name": "Norgestimate-Eth Estradiol Tablet 0.25-35 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804015828",
      "ndc_label_name": "Norgestimate-Eth Estradiol Tablet 0.25-35 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462030929",
      "ndc_label_name": "Norgestimate-Eth Estradiol TABLET 0.25-35 MG-MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462030984",
      "ndc_label_name": "Norgestimate-Eth Estradiol TABLET 0.25-35 MG-MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789043479",
      "ndc_label_name": "Norgestimate-Eth Estradiol Tablet 0.25-35 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "46287003515",
      "ndc_label_name": "Norliqva Solution 1 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253011135",
      "ndc_label_name": "Normal Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253011123",
      "ndc_label_name": "Normal Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253011125",
      "ndc_label_name": "Normal Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253011122",
      "ndc_label_name": "Normal Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253011152",
      "ndc_label_name": "Normal Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253011133",
      "ndc_label_name": "Normal Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253011121",
      "ndc_label_name": "Normal Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253011130",
      "ndc_label_name": "Normal Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555900879",
      "ndc_label_name": "Nortrel 0.5/35 (28) TABLET 0.5-35 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555900867",
      "ndc_label_name": "Nortrel 0.5/35 (28) TABLET 0.5-35 MG-MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090322900",
      "ndc_label_name": "Nortrel 0.5/35 (28) Tablet 0.5-35 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555900980",
      "ndc_label_name": "Nortrel 1/35 (21) TABLET 1-35 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555900942",
      "ndc_label_name": "Nortrel 1/35 (21) TABLET 1-35 MG-MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555901258",
      "ndc_label_name": "Nortrel 7/7/7 TABLET 0.5/0.75/1-35 MG-MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555901279",
      "ndc_label_name": "Nortrel 7/7/7 TABLET 0.5/0.75/1-35 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999053860",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268060315",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093081001",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090717400",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400101",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090053700",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093081005",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090053701",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090717401",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400106",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400102",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436665201",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862094501",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959035890",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959035830",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043590",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268060311",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959035802",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687028111",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629320403",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043530",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687090001",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687028101",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629320402",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400105",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959035860",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856703",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267048360",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187071530",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687090011",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760050830",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788815803",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862094505",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267048345",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760090860",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788890003",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629320404",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629320401",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919085390",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205077030",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959035820",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189056330",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907006905",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335174301",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043560",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907006901",
      "ndc_label_name": "Nortriptyline HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400206",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093081101",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268060411",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062830",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063089730",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268060415",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093081105",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050700",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959035902",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063072230",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400202",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090050703",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959035930",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400201",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090719103",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959035950",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959035920",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862094601",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629283301",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090719100",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959035960",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959035990",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436402202",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760090930",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700050130",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687091101",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789042530",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862094605",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687029311",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687029301",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400205",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017160",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760081130",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687091111",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700050160",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267048445",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028530",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028560",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187015330",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919028590",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544007892",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017130",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039630",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544007853",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544007830",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039690",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187039660",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267048460",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820201",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820203",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544007880",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544007870",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872103",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544007860",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820209",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008304",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820206",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788983003",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788983001",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872101",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788983006",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856803",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189056160",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008309",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008302",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008306",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029901",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788983009",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205025430",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872106",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029902",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335235004",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008307",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335172602",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425040103",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189056190",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610078530",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872109",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008308",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425040102",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907007001",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189056130",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029903",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907007005",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053401",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008305",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425040101",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804013930",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335172604",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610078560",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053402",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053403",
      "ndc_label_name": "Nortriptyline HCl Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760040130",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999091590",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051915",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400301",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035390",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093081201",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268060515",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090132200",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919023860",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090132300",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187079860",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862094705",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187008830",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093081205",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400305",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400302",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721601",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268060511",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051930",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687026533",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189056230",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074230",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035330",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862094701",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721606",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051960",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187079890",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919059060",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189056260",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187079830",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071032330",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700066830",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907007105",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687026532",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071032390",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919023830",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335177301",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017730",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919035360",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187075960",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919059030",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907007101",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187075990",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071032360",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721603",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721609",
      "ndc_label_name": "Nortriptyline HCl Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093081305",
      "ndc_label_name": "Nortriptyline HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093081301",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400406",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400402",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400401",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959084060",
      "ndc_label_name": "Nortriptyline HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862094801",
      "ndc_label_name": "Nortriptyline HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187022730",
      "ndc_label_name": "Nortriptyline HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907007201",
      "ndc_label_name": "Nortriptyline HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335219901",
      "ndc_label_name": "Nortriptyline HCl Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672400405",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080930",
      "ndc_label_name": "Nortriptyline HCl CAPSULE 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074194063",
      "ndc_label_name": "Norvir Solution 80 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462550047",
      "ndc_label_name": "Nose Clip",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80631010310",
      "ndc_label_name": "Novavax COVID-19 Vaccine Suspension 5 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80631010502",
      "ndc_label_name": "Novavax COVID-19 Vaccine Suspension 5 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80631010501",
      "ndc_label_name": "Novavax COVID-19 Vaccine Suspension 5 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80631010301",
      "ndc_label_name": "Novavax COVID-19 Vaccine Suspension 5 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "89411029101",
      "ndc_label_name": "Nu-Iron Capsule 150 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00259029101",
      "ndc_label_name": "Nu-Iron CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68982014301",
      "ndc_label_name": "Nuwiq Kit 1000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982013901",
      "ndc_label_name": "Nuwiq Kit 250 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68982014101",
      "ndc_label_name": "Nuwiq Kit 500 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713067815",
      "ndc_label_name": "Nystatin CREAM 100000 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168005430",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342046915",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713067831",
      "ndc_label_name": "Nystatin CREAM 100000 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168005415",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00316022130",
      "ndc_label_name": "Nystatin CREAM 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342046930",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00316022115",
      "ndc_label_name": "Nystatin CREAM 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999025130",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959055101",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090730300",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802005911",
      "ndc_label_name": "Nystatin CREAM 100000 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090377200",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802005935",
      "ndc_label_name": "Nystatin CREAM 100000 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090276300",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668059501",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267095230",
      "ndc_label_name": "Nystatin CREAM 100000 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002093863",
      "ndc_label_name": "Nystatin CREAM 100000 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794901",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959055103",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651090730",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090024100",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090285400",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668059502",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788823401",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651090714",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863101",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804004530",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788751303",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090024500",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672128901",
      "ndc_label_name": "Nystatin CREAM 100000 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002093866",
      "ndc_label_name": "Nystatin CREAM 100000 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162138502",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788751301",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162257603",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629869401",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004615",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672128902",
      "ndc_label_name": "Nystatin CREAM 100000 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335283001",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267095315",
      "ndc_label_name": "Nystatin CREAM 100000 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162138503",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794903",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162249602",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788863103",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804004515",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629869501",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162249603",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788823403",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162257602",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788843601",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189027815",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040815",
      "ndc_label_name": "Nystatin Cream 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162200702",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629251601",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584500",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168000730",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713068615",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578008904",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168000715",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472016630",
      "ndc_label_name": "Nystatin OINTMENT 100000 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802004811",
      "ndc_label_name": "Nystatin OINTMENT 100000 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342048115",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315030730",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713068631",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629251501",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342048130",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472016615",
      "ndc_label_name": "Nystatin OINTMENT 100000 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668053401",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162233302",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315030715",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205043715",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802004835",
      "ndc_label_name": "Nystatin OINTMENT 100000 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668053402",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162200703",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090023300",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162233303",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002082263",
      "ndc_label_name": "Nystatin OINTMENT 100000 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578008901",
      "ndc_label_name": "Nystatin Ointment 100000 UNIT/GM External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121086805",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383058716",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121086800",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121086816",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121104516",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121086802",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121086850",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527512170",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121478505",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135081305",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904727692",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856050807",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090174000",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121086840",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154157805",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856104501",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121478535",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85742001310",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856104507",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383058766",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325700",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527512162",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687080017",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090531500",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999077302",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904727670",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959049660",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672411704",
      "ndc_label_name": "Nystatin SUSPENSION 100000 UNIT/ML MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629851901",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432053716",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135081347",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672411709",
      "ndc_label_name": "Nystatin SUSPENSION 100000 UNIT/ML MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687080040",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267095160",
      "ndc_label_name": "Nystatin SUSPENSION 100000 UNIT/ML MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135081346",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432053760",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739016010",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689003701",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689000816",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118003306",
      "ndc_label_name": "Nystatin SUSPENSION 100000 UNIT/ML MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70166033105",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094059959",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739016056",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629249301",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689000802",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135081324",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689003799",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094059962",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033001554",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629249201",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788679206",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629852101",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795606",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689003750",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094059961",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788856104",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315050447",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315050460",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834023516",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834023560",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033001501",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85742001311",
      "ndc_label_name": "Nystatin Suspension 100000 UNIT/ML Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155005101",
      "ndc_label_name": "Nystatin TABLET 500000 UNIT ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289013040",
      "ndc_label_name": "Nystatin TABLET 500000 UNIT ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135074190",
      "ndc_label_name": "Nystatin Tablet 500000 UNIT Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093098301",
      "ndc_label_name": "Nystatin TABLET 500000 UNIT ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869001",
      "ndc_label_name": "Nystatin Tablet 500000 UNIT Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291065190",
      "ndc_label_name": "Nystatin Tablet 500000 UNIT Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205057530",
      "ndc_label_name": "Nystatin Tablet 500000 UNIT Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959064820",
      "ndc_label_name": "Nystatin Tablet 500000 UNIT Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489040001",
      "ndc_label_name": "Nystatin Tablet 500000 UNIT Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162112402",
      "ndc_label_name": "Nystop Powder 100000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629869801",
      "ndc_label_name": "Nystop Powder 100000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574200802",
      "ndc_label_name": "Nystop POWDER 100000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574200815",
      "ndc_label_name": "Nystop POWDER 100000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629869701",
      "ndc_label_name": "Nystop Powder 100000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574200830",
      "ndc_label_name": "Nystop POWDER 100000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629869601",
      "ndc_label_name": "Nystop Powder 100000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335284501",
      "ndc_label_name": "Nystop Powder 100000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162112403",
      "ndc_label_name": "Nystop Powder 100000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335286901",
      "ndc_label_name": "Nystop Powder 100000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162112406",
      "ndc_label_name": "Nystop Powder 100000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00813020201",
      "ndc_label_name": "O-Cal Prenatal Tablet Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641617501",
      "ndc_label_name": "Octreotide Acetate SOLUTION 100 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641617510",
      "ndc_label_name": "Octreotide Acetate SOLUTION 100 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155068841",
      "ndc_label_name": "Octreotide Acetate Solution 100 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155068831",
      "ndc_label_name": "Octreotide Acetate Solution 100 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323037601",
      "ndc_label_name": "Octreotide Acetate SOLUTION 100 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462089601",
      "ndc_label_name": "Octreotide Acetate Solution 100 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703331104",
      "ndc_label_name": "Octreotide Acetate Solution 100 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323037641",
      "ndc_label_name": "Octreotide Acetate Solution 100 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288056702",
      "ndc_label_name": "Octreotide Acetate Solution 100 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703331101",
      "ndc_label_name": "Octreotide Acetate Solution 100 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021045201",
      "ndc_label_name": "Octreotide Acetate Solution 100 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323037600",
      "ndc_label_name": "Octreotide Acetate Solution 100 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021046401",
      "ndc_label_name": "Octreotide Acetate Solution 100 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462089610",
      "ndc_label_name": "Octreotide Acetate Solution 100 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323037604",
      "ndc_label_name": "Octreotide Acetate SOLUTION 100 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71288056701",
      "ndc_label_name": "Octreotide Acetate Solution 100 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629883101",
      "ndc_label_name": "Octreotide Acetate Solution 100 MCG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457024500",
      "ndc_label_name": "Octreotide Acetate Solution Prefilled Syringe 100 MCG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457024501",
      "ndc_label_name": "Octreotide Acetate Solution Prefilled Syringe 100 MCG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090234000",
      "ndc_label_name": "Odefsey Tablet 200-25-25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958210101",
      "ndc_label_name": "Odefsey TABLET 200-25-25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00761017120",
      "ndc_label_name": "Odorless Coated Fish Oil Capsule Delayed Release 1000 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090089100",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904743410",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090679500",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208043405",
      "ndc_label_name": "Ofloxacin SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999089110",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090520900",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904743405",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090174400",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760097005",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208043410",
      "ndc_label_name": "Ofloxacin SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002132402",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090776100",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090679400",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959076310",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071310",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090542500",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187073405",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090518600",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980051505",
      "ndc_label_name": "Ofloxacin SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436611200",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59390014005",
      "ndc_label_name": "Ofloxacin SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002132401",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478071311",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436071301",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788844905",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959076305",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512079305",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512079310",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505056000",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919017505",
      "ndc_label_name": "Ofloxacin SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090134600",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760091705",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069041101",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145014101",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756065030",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189047205",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788817805",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788769305",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090726400",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980051501",
      "ndc_label_name": "Ofloxacin SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788819505",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145014201",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162210802",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315032705",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603019202",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788826405",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505056001",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315032710",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788876105",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804010105",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756060730",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485061310",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205042005",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72485061311",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603019201",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090720700",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24208041005",
      "ndc_label_name": "Ofloxacin SOLUTION 0.3 % OTIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980043205",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002160402",
      "ndc_label_name": "Ofloxacin SOLUTION 0.3 % OTIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090109000",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959097905",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383002505",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756061030",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315032010",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24208041010",
      "ndc_label_name": "Ofloxacin SOLUTION 0.3 % OTIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189010805",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919093105",
      "ndc_label_name": "Ofloxacin SOLUTION 0.3 % OTIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090173600",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65145014401",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980043201",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65145014301",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189049005",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567000",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238161606",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069068601",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090383600",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238161503",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170902",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756060915",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383002510",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629871601",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603018601",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335282201",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002160401",
      "ndc_label_name": "Ofloxacin SOLUTION 0.3 % OTIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315032005",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505036301",
      "ndc_label_name": "Ofloxacin SOLUTION 0.3 % OTIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069068701",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505036302",
      "ndc_label_name": "Ofloxacin SOLUTION 0.3 % OTIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603018602",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788855101",
      "ndc_label_name": "Ofloxacin Solution 0.3 % Otic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904637661",
      "ndc_label_name": "OLANZapine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832608150",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090310000",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700092730",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007007",
      "ndc_label_name": "OLANZapine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084618",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832608103",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187036430",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429062310",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090269300",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429062330",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505311308",
      "ndc_label_name": "OLANZapine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162236800",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598016605",
      "ndc_label_name": "OLANZapine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007015",
      "ndc_label_name": "OLANZapine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056499",
      "ndc_label_name": "OLANZapine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505311300",
      "ndc_label_name": "OLANZapine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056430",
      "ndc_label_name": "OLANZapine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598016630",
      "ndc_label_name": "OLANZapine TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543038330",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993068330",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700086230",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966103",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084074001",
      "ndc_label_name": "OLANZapine TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543038390",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084074011",
      "ndc_label_name": "OLANZapine TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241005411",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966102",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241005422",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015701",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015702",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015703",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335966101",
      "ndc_label_name": "OLANZapine Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007115",
      "ndc_label_name": "OLANZapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832608250",
      "ndc_label_name": "OLANZapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111016730",
      "ndc_label_name": "OLANZapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832608203",
      "ndc_label_name": "OLANZapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904628661",
      "ndc_label_name": "OLANZapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429062430",
      "ndc_label_name": "OLANZapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505311403",
      "ndc_label_name": "OLANZapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084052811",
      "ndc_label_name": "OLANZapine TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505311400",
      "ndc_label_name": "OLANZapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007107",
      "ndc_label_name": "OLANZapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505311408",
      "ndc_label_name": "OLANZapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904628606",
      "ndc_label_name": "OLANZapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993068430",
      "ndc_label_name": "OLANZapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241005522",
      "ndc_label_name": "OLANZapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205048730",
      "ndc_label_name": "OLANZapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543038430",
      "ndc_label_name": "OLANZapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610041930",
      "ndc_label_name": "OLANZapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111016705",
      "ndc_label_name": "OLANZapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015802",
      "ndc_label_name": "OLANZapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056599",
      "ndc_label_name": "OLANZapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015801",
      "ndc_label_name": "OLANZapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543038490",
      "ndc_label_name": "OLANZapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429062410",
      "ndc_label_name": "OLANZapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241005511",
      "ndc_label_name": "OLANZapine Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056530",
      "ndc_label_name": "OLANZapine TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084052801",
      "ndc_label_name": "OLANZapine TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056199",
      "ndc_label_name": "OLANZapine TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342006744",
      "ndc_label_name": "OLANZapine TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111016305",
      "ndc_label_name": "OLANZapine TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700080930",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832607850",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832607803",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429062010",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904628361",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084052501",
      "ndc_label_name": "OLANZapine TABLET 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543038030",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543038090",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335176001",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342006707",
      "ndc_label_name": "OLANZapine TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084052511",
      "ndc_label_name": "OLANZapine TABLET 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505311003",
      "ndc_label_name": "OLANZapine TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111016330",
      "ndc_label_name": "OLANZapine TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241005111",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162210900",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015402",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505311008",
      "ndc_label_name": "OLANZapine TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429062030",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015401",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056130",
      "ndc_label_name": "OLANZapine TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189047830",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505311000",
      "ndc_label_name": "OLANZapine TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015403",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335176004",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241005122",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993068030",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788401203",
      "ndc_label_name": "OLANZapine Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015902",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904628761",
      "ndc_label_name": "OLANZapine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832608350",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904628706",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832608303",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095416",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505314008",
      "ndc_label_name": "OLANZapine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056630",
      "ndc_label_name": "OLANZapine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007207",
      "ndc_label_name": "OLANZapine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007215",
      "ndc_label_name": "OLANZapine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084052901",
      "ndc_label_name": "OLANZapine TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111016805",
      "ndc_label_name": "OLANZapine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111016830",
      "ndc_label_name": "OLANZapine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505314003",
      "ndc_label_name": "OLANZapine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015903",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993068530",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429062510",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084052911",
      "ndc_label_name": "OLANZapine TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804006730",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429062530",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505314000",
      "ndc_label_name": "OLANZapine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056699",
      "ndc_label_name": "OLANZapine TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543038530",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241005622",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543038590",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241005611",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015901",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789034190",
      "ndc_label_name": "OLANZapine Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832607903",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342006807",
      "ndc_label_name": "OLANZapine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429062110",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904637761",
      "ndc_label_name": "OLANZapine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598016405",
      "ndc_label_name": "OLANZapine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187084403",
      "ndc_label_name": "OLANZapine TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090308100",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598016430",
      "ndc_label_name": "OLANZapine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832607950",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084072301",
      "ndc_label_name": "OLANZapine TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056230",
      "ndc_label_name": "OLANZapine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342006844",
      "ndc_label_name": "OLANZapine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429062101",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716103",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872203",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429062130",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505311100",
      "ndc_label_name": "OLANZapine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335071401",
      "ndc_label_name": "OLANZapine TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335053403",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505311108",
      "ndc_label_name": "OLANZapine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993068130",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162211003",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335136301",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084072311",
      "ndc_label_name": "OLANZapine TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056299",
      "ndc_label_name": "OLANZapine TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241005222",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241005211",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716106",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872206",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818503",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162211000",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716109",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543038190",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818506",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015502",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818509",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788872209",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543038130",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015501",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015503",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046014",
      "ndc_label_name": "OLANZapine Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598016530",
      "ndc_label_name": "OLANZapine TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832608050",
      "ndc_label_name": "OLANZapine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505311208",
      "ndc_label_name": "OLANZapine TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342006907",
      "ndc_label_name": "OLANZapine TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832608003",
      "ndc_label_name": "OLANZapine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342006944",
      "ndc_label_name": "OLANZapine TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056399",
      "ndc_label_name": "OLANZapine TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543038230",
      "ndc_label_name": "OLANZapine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241005311",
      "ndc_label_name": "OLANZapine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598016505",
      "ndc_label_name": "OLANZapine TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603015601",
      "ndc_label_name": "OLANZapine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429062230",
      "ndc_label_name": "OLANZapine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505311200",
      "ndc_label_name": "OLANZapine TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241005322",
      "ndc_label_name": "OLANZapine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056330",
      "ndc_label_name": "OLANZapine TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543038290",
      "ndc_label_name": "OLANZapine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993068230",
      "ndc_label_name": "OLANZapine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429062210",
      "ndc_label_name": "OLANZapine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189057830",
      "ndc_label_name": "OLANZapine Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342017307",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590901",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729036615",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668025190",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722088630",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668025130",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722088690",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039109",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039103",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664075899",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090569401",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291092490",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305300",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729036610",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342017310",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305301",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090370101",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014990",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090602700",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590900",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090602701",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090569400",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305400",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747801",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090683601",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603029001",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747800",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090683600",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090653701",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603029002",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090370100",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205017330",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664075883",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756081230",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332014930",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090653700",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862077930",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862077990",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877045390",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877045330",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756081290",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090540200",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668025230",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668025290",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877045290",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729036715",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342017410",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722088790",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090712700",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862078030",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729036710",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722088730",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756081390",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090757100",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291092590",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332015030",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090356100",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603029102",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039209",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342017407",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090334800",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664075983",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664075999",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039203",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862078090",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756081330",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332015090",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603029101",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877045230",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722088830",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729036810",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664076083",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668025330",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603029202",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729036815",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342017507",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090437700",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039309",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342017510",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877045190",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668025390",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332015190",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291092690",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862078130",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090545000",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756081430",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547039303",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756081490",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722088890",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603029201",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877045130",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090704500",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664076099",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205017590",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332015130",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862078190",
      "ndc_label_name": "Olmesartan Medoxomil-HCTZ TABLET 40-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407066305",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536144540",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598076507",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536130840",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58602000640",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16571088205",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51407049905",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090356600",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784305",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090355200",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980051705",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478030805",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70069000701",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293083885",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70512052005",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65862075705",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72657016850",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60505057501",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090634100",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60429095705",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069001701",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000071701",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72189005305",
      "ndc_label_name": "Olopatadine HCl Solution 0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001053069",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "59651006605",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090561300",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16571086125",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "17478030512",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598076402",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090348900",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536130723",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72657019411",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000071601",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58602000739",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60505058604",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72657019425",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001067492",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "62332050203",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069049101",
      "ndc_label_name": "Olopatadine HCl Solution 0.2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "04351066501",
      "ndc_label_name": "Ombra Compressor Air Filters",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "73141011701",
      "ndc_label_name": "Omega-3 Fish Oil Capsule 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "48433011001",
      "ndc_label_name": "Omega-3 Fish Oil CAPSULE 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "79854006900",
      "ndc_label_name": "Omega-3 Fish Oil CAPSULE 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54458000022",
      "ndc_label_name": "Omega-3 Fish Oil CAPSULE 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845012234",
      "ndc_label_name": "Omega-3 Fish Oil Capsule 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985022921",
      "ndc_label_name": "Omega-3 Fish Oil CAPSULE 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "47469004040",
      "ndc_label_name": "Omega-3 Fish Oil CAPSULE 1000 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73141013501",
      "ndc_label_name": "Omega-3 Fish Oil Capsule 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73141011601",
      "ndc_label_name": "Omega-3 Fish Oil Capsule 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "73141011801",
      "ndc_label_name": "Omega-3 Fish Oil Capsule 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68094011961",
      "ndc_label_name": "Omega-3 Fish Oil Capsule 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "16714071401",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999061100",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781285910",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505014501",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781285901",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111064330",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999061160",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781285931",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111015730",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016001",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135055930",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382041101",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111015701",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651000130",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651000101",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111064301",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135053090",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135053030",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205050160",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016030",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66685042101",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505014500",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804016660",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175011432",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175011437",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66685042100",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462039530",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080560",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505014502",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462039501",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462039590",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205050130",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781286810",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904691761",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714071503",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440787830",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440787890",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781286892",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440787860",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714063402",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781286831",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999026590",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063021293",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063021214",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714071501",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714063401",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440787892",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063074360",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714063403",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082803",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082805",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063021230",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063074330",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714071502",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781286801",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999026560",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063074390",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306006",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082806",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063021290",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082800",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999026514",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063074314",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082807",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090115701",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306008",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090115700",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999026540",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090290107",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999026530",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082802",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090082808",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090290104",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306009",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090290103",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090290100",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306002",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090290102",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387604",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090290108",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306003",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387602",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090290106",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306004",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590100",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090290105",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387606",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306000",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387608",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387603",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090290109",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306005",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090669607",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721308",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387607",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590102",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590108",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387605",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590300",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090306007",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721300",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747207",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090511100",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590104",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090669600",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590107",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090669700",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387600",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721302",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436039602",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590103",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590200",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090701900",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090669604",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721304",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090701800",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721303",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436815802",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590105",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090669603",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721305",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090701804",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721307",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090702100",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747204",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407012990",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590106",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090669606",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747203",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090701806",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747206",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721306",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436815801",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072218",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090669602",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090701802",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747208",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747200",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407025601",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721500",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407012930",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111015834",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090669605",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090701807",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268065615",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747205",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407064101",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407025610",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081301",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016130",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090669608",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721400",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436006501",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268061915",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407064110",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407028790",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072210",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651000290",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090701803",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268061911",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436006502",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436006503",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081330",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407064190",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072220",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505006500",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090701805",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268065611",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081310",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407028710",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072290",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016190",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072275",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505006501",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090701808",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436039601",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072214",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072215",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111015830",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505006508",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111064401",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760086860",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747202",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436312501",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059711",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111015801",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505006502",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760086807",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059701",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760086890",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747300",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436312503",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760048907",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651000299",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760048930",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919080707",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078730",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919080714",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747400",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072200",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760074790",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505006507",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760086830",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071023090",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078778",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082006",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436312502",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072260",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017615",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919080760",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175011837",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788688103",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078790",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082014",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407012901",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111064410",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544051030",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629260707",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175011843",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788688106",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082060",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084012801",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407012910",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760048960",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071023015",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267101730",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544051032",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788688109",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629260710",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762602",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407028701",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760048990",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084012811",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544051070",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382041205",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862202",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267101703",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762608",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081390",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919080715",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462039690",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462039601",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762609",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862203",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071023030",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880506",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959072230",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175011832",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789803",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788688102",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880504",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008003",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071023060",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008001",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111015810",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082030",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789806",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788688108",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880509",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700015010",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382041201",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090700",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111064430",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082078",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880501",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762604",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886403",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061314",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789801",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095955",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016199",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082090",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677018060",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862204",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008000",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095930",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862209",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033200",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651000205",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544051053",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700015001",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862206",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090730",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095960",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880503",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033205",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760083330",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544051080",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934001460",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886409",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033203",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033202",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677018001",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335056902",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017614",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544051094",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934011830",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934011890",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033204",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033207",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677018090",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335056905",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919080730",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071200806",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061330",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090711",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033209",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033208",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700015030",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335056908",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187007030",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071200809",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090790",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095911",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335056906",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335056900",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934011860",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040780",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187007060",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462039610",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033206",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335163904",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335056909",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040770",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934047990",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091253",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544051060",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762601",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335056901",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335174601",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040730",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420005503",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061306",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048260",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462039630",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762603",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335174602",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185200",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040760",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007101",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061390",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420005506",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788688101",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762606",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335174603",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185203",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066356",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509139601",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095900",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007002",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788688104",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880502",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185208",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185205",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094253",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880507",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335056903",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007103",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789809",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886401",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335960901",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066360",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094260",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886402",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185201",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041501",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862201",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886404",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335960902",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094280",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096360",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677018030",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185206",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008007790",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862208",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008005",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066330",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048230",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096380",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518008006",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066353",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509139609",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886406",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090760",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066387",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008007730",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007001",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095990",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091260",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509139606",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788886408",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335033201",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096370",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335056904",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007102",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335056907",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094230",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185202",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061360",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040794",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050402",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066351",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041504",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066380",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048290",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066394",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090755",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091230",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509164406",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789048214",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008007760",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007003",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420005510",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041502",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335174604",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050401",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007004",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009002210",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509164409",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509164401",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041503",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335174605",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009018310",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185204",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185207",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185209",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040753",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610066370",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091280",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050403",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050404",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509139602",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509139603",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509164403",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781223401",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781223431",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781223410",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082960",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090137001",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714012302",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714074802",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714012301",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045190",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736600",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090137000",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090276900",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090137002",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714012303",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353082980",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090672001",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090276902",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436312601",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436014601",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062011",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736603",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090672002",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090276901",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090672100",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090550100",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407013030",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407030301",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268065711",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736700",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736602",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090276903",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407066401",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062015",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111015901",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111015905",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436312602",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407013090",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407013005",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090672000",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016201",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268065715",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111015910",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111064510",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407013001",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407066405",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016290",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736601",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084714",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407030310",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788699508",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700041060",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081405",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700041030",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651000305",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081490",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175013643",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081401",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789603",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651000330",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081605",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016250",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505014602",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081690",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382050005",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081430",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877101",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060811",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081630",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060801",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382050010",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407094390",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462039710",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407081601",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934001590",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175013632",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407094305",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760039530",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462039730",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991064405",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462039790",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407094301",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335029905",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187017030",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111015930",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919024114",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877109",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111064530",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934001530",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111064505",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024860",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082830",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111064501",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084730",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335029901",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505014601",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096090",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111064534",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040880",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789601",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651000301",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082860",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068843",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919077390",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028053",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016230",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016902",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096000",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505014600",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462039701",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070480",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382050001",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028060",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919024130",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087570",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335029904",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919077330",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788699503",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087680",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788699501",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610032660",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919024160",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088030",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185101",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084760",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788699506",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088053",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780409",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068880",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919024190",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088060",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185104",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175013637",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788699509",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162238805",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877108",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087660",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084790",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162238806",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028080",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780403",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780401",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010901",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934048630",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016901",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082890",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780406",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040830",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788780408",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789608",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877103",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335029902",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877106",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071152203",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205015760",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040853",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096060",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934033630",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335153202",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335153201",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068830",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789606",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068853",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087653",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068887",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096011",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070430",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068858",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087560",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789609",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088080",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162238800",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025790",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096055",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009002305",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070460",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700015110",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087553",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335029903",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162238803",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934048690",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162238809",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335029906",
      "ndc_label_name": "Omeprazole CAPSULE DELAYED RELEASE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205015790",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185102",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205096030",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185105",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610028030",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610029760",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040860",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087580",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068860",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087670",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789015590",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162238802",
      "ndc_label_name": "Omeprazole Capsule Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111039728",
      "ndc_label_name": "Omeprazole Magnesium CAPSULE DELAYED RELEASE 20.6 (20 Base) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55111039752",
      "ndc_label_name": "Omeprazole Magnesium CAPSULE DELAYED RELEASE 20.6 (20 Base) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660006144",
      "ndc_label_name": "Omeprazole Magnesium Capsule Delayed Release 20.6 (20 Base) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69618004742",
      "ndc_label_name": "Omeprazole Magnesium Capsule Delayed Release 20.6 (20 Base) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917012777",
      "ndc_label_name": "Omeprazole Magnesium Capsule Delayed Release 20.6 (20 Base) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363039752",
      "ndc_label_name": "Omeprazole Magnesium CAPSULE DELAYED RELEASE 20.6 (20 Base) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363039733",
      "ndc_label_name": "Omeprazole Magnesium CAPSULE DELAYED RELEASE 20.6 (20 Base) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69618004714",
      "ndc_label_name": "Omeprazole Magnesium Capsule Delayed Release 20.6 (20 Base) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55111039727",
      "ndc_label_name": "Omeprazole Magnesium CAPSULE DELAYED RELEASE 20.6 (20 Base) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917012776",
      "ndc_label_name": "Omeprazole Magnesium Capsule Delayed Release 20.6 (20 Base) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55111039733",
      "ndc_label_name": "Omeprazole Magnesium CAPSULE DELAYED RELEASE 20.6 (20 Base) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55111039742",
      "ndc_label_name": "Omeprazole Magnesium CAPSULE DELAYED RELEASE 20.6 (20 Base) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55111039774",
      "ndc_label_name": "Omeprazole Magnesium CAPSULE DELAYED RELEASE 20.6 (20 Base) MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896075942",
      "ndc_label_name": "Omeprazole Magnesium Capsule Delayed Release 20.6 (20 Base) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536132213",
      "ndc_label_name": "Omeprazole Magnesium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536132271",
      "ndc_label_name": "Omeprazole Magnesium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000052103",
      "ndc_label_name": "Omeprazole Magnesium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090688800",
      "ndc_label_name": "Omeprazole Magnesium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000052104",
      "ndc_label_name": "Omeprazole Magnesium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230031837",
      "ndc_label_name": "Omeprazole Magnesium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000052102",
      "ndc_label_name": "Omeprazole Magnesium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536132288",
      "ndc_label_name": "Omeprazole Magnesium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230031835",
      "ndc_label_name": "Omeprazole Magnesium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69230031836",
      "ndc_label_name": "Omeprazole Magnesium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000052101",
      "ndc_label_name": "Omeprazole Magnesium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800091530",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363091555",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536144813",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113091530",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363000703",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113091574",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363091501",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363091530",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917021328",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142091574",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802088855",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113091555",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800091555",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536144888",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363091503",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800091503",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001044198",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800091501",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001044140",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142091555",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800091574",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30142091530",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000072301",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802088830",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660002944",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896065942",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000072303",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49614023830",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68001044139",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43598028633",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49614023855",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000072302",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660002914",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660002927",
      "ndc_label_name": "Omeprazole Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51552135001",
      "ndc_label_name": "Omeprazole+Syrspend SF Alka Suspension 2 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51552144306",
      "ndc_label_name": "Omeprazole+Syrspend SF Alka Suspension 2 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51552144305",
      "ndc_label_name": "Omeprazole+Syrspend SF Alka Suspension 2 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781401471",
      "ndc_label_name": "Omnitrope SOLUTION RECONSTITUTED 5.8 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781400436",
      "ndc_label_name": "Omnitrope SOLUTION RECONSTITUTED 5.8 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856069105",
      "ndc_label_name": "Ondansetron HCl SOLUTION 4 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856055503",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904707393",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268064711",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904707341",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856055502",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054006447",
      "ndc_label_name": "Ondansetron HCl SOLUTION 4 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687025240",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672409103",
      "ndc_label_name": "Ondansetron HCl SOLUTION 4 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54838055550",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094076362",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162069179",
      "ndc_label_name": "Ondansetron HCl SOLUTION 4 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714067102",
      "ndc_label_name": "Ondansetron HCl SOLUTION 4 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856067204",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135055524",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788836505",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999055545",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135055545",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999055524",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268064714",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094076359",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687025286",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135055558",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205010950",
      "ndc_label_name": "Ondansetron HCl Solution 4 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409475901",
      "ndc_label_name": "Ondansetron HCl SOLUTION 40 MG/20ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143989010",
      "ndc_label_name": "Ondansetron HCl SOLUTION 40 MG/20ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143989001",
      "ndc_label_name": "Ondansetron HCl SOLUTION 40 MG/20ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150012620",
      "ndc_label_name": "Ondansetron HCl SOLUTION 40 MG/20ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266012401",
      "ndc_label_name": "Ondansetron HCl Solution 40 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641628601",
      "ndc_label_name": "Ondansetron HCl Solution 40 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729029805",
      "ndc_label_name": "Ondansetron HCl SOLUTION 40 MG/20ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641607901",
      "ndc_label_name": "Ondansetron HCl SOLUTION 40 MG/20ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323037420",
      "ndc_label_name": "Ondansetron HCl SOLUTION 40 MG/20ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155055031",
      "ndc_label_name": "Ondansetron HCl SOLUTION 40 MG/20ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860077721",
      "ndc_label_name": "Ondansetron HCl Solution 40 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860077720",
      "ndc_label_name": "Ondansetron HCl Solution 40 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155054931",
      "ndc_label_name": "Ondansetron HCl SOLUTION 40 MG/20ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440788204",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440788206",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440788210",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090634201",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904655161",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317802",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440788202",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090160004",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090160000",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063074612",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714015901",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090634202",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062111",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317805",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111015313",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317800",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317804",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013204",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963053830",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700063130",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062115",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090634204",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046430",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111015330",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013201",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407000330",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317801",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063601",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436018701",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700063110",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056545",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700063106",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436018704",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756013001",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090634200",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760063616",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407000305",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760063620",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187023610",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237007550",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063611",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187063603",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090634205",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760063630",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237007530",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056530",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187063606",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046410",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760063610",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187063615",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700063120",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187063610",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056510",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135035005",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187063612",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187063620",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056512",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629402300",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056590",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788936802",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187063601",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629402303",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304045830",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187063630",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056520",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629402301",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629402306",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934014810",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788936801",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017103",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629402302",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629402308",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056560",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084022011",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629402307",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020507",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788936806",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020500",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841801",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629402309",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135035030",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841803",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462010530",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930001752",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934014804",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185500",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865105",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084022001",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629402304",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865101",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788989305",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162236405",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930001730",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509105704",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788936805",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841802",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629402305",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865106",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017105",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007202",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007203",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509107502",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185503",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841805",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862018730",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788936803",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934014806",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865103",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509107501",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509107503",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007204",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020501",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788841806",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185509",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020503",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185501",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788865102",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509107505",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008007430",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007205",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017101",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335020504",
      "ndc_label_name": "Ondansetron HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335185508",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789003412",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007201",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509107504",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008007420",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509107506",
      "ndc_label_name": "Ondansetron HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079206",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714016001",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090101501",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353088188",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440788304",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440788302",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090101502",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963053930",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090467103",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090101504",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090467101",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090101503",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904655261",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063077006",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318502",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090101500",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090467104",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090467100",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407000430",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318500",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008710",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318501",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090467102",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062211",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062215",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111015430",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237007650",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318503",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008720",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090318504",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700062712",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407000405",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013101",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700062710",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760063710",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436188001",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135035105",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700062720",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700062730",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959098003",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436045901",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046510",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760063715",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687064701",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084022111",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760063730",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919046530",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111015413",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237007630",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629409301",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760065815",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877017030",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858202",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760065810",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187006530",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760065860",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687064711",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629409306",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008730",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017203",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788940201",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760065820",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187051330",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008715",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629409304",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629409307",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187070915",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934026410",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007503",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756013101",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187070910",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008760",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629409305",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084022101",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187070930",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930001852",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509107602",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187051310",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629409309",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135035130",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862018830",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858203",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629409302",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007405",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509107603",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304045930",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739033310",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187070906",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788940202",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858206",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629409303",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007501",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788940205",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788989202",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074410",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462010630",
      "ndc_label_name": "Ondansetron HCl TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629409308",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335135702",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074430",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007504",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858201",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074412",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007401",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788858205",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788940203",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335135707",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007402",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788940206",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339017201",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007403",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007502",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509107605",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335135708",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930001830",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007505",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007404",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011988",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162236505",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509107601",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509107606",
      "ndc_label_name": "Ondansetron HCl Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090165802",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714020010",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356019765",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090120002",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085704",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378773293",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090120003",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085702",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090165900",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714020030",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085706",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090165800",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090120001",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700067210",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090165801",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085705",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760065410",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291045730",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090120100",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090165803",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436039001",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187025605",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090234303",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085708",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000215",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013301",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090234300",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919054510",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237007750",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187025606",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700067265",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085710",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187025610",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919054530",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090234301",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756024064",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760030510",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037920",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700095265",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085720",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187025612",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187025630",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013401",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187052606",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020130",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037930",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000210",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090120000",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187025615",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037906",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959042510",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187052620",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135012130",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187052603",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037910",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090234302",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037915",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187052615",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237007730",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187052630",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000230",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187052610",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037912",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237007710",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187052605",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462015713",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187052604",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629401403",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187025620",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629401401",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187067030",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760027710",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001024616",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934029495",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629401400",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071069204",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037903",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629401404",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629401405",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000220",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071069206",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065004",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629401402",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071201101",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037905",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071200904",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001024617",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187025604",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462015740",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335297203",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862039010",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866601",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001024604",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764401",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065005",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187052612",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065003",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335297205",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071069202",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69677018230",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065001",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866605",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065006",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764403",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335297204",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007302",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071069210",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065002",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335131402",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934029484",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335297201",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518351200",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021710",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335131403",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764405",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065007",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335297202",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021704",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335297206",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934063495",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425022802",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420005610",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866603",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065008",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335297207",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047301",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420005620",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420005630",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420005604",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021730",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788967001",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420005606",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046901",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021720",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335131401",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425007301",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008002610",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425022803",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335131404",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008002665",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420021706",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980001213",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425022801",
      "ndc_label_name": "Ondansetron Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090166000",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090166003",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291045830",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714020130",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063027304",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087004",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378773497",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378773493",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187069320",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090534603",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090112803",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090112802",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087002",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090534600",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714020110",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090112800",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788770503",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760030610",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090166002",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090166001",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090112801",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237007810",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087010",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090463203",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090463200",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760093610",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760031310",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655080987",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090534601",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237007830",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090463201",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090534602",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237007850",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629430607",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756035664",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135012230",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919098630",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919021830",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090463202",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629430606",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756035666",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462015811",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187019930",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187026630",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187048310",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919098610",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760056710",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862039110",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629430603",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934080983",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187026615",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187069330",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001024717",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187019920",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629430602",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001024716",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788770501",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025110",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934020695",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788756503",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934044883",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187026620",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629430604",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788756506",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335107101",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187069310",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205071320",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934080987",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425022701",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629430601",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629430605",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934020687",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462015813",
      "ndc_label_name": "Ondansetron TABLET DISPERSIBLE 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001024704",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788756501",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335173101",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205071330",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205071310",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025106",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934044895",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425022201",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025120",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025104",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420025130",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934080995",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335107102",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980001313",
      "ndc_label_name": "Ondansetron Tablet Dispersible 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16500055281",
      "ndc_label_name": "One-A-Day Womens Prenatal 28-0.8 & 223 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16500055283",
      "ndc_label_name": "One-A-Day Womens Prenatal 28-0.8 & 223 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66215050130",
      "ndc_label_name": "Opsumit TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66215050115",
      "ndc_label_name": "Opsumit TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00113200312",
      "ndc_label_name": "Option 2 TABLET 1.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51167050002",
      "ndc_label_name": "Orkambi Packet 150-188 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51167070002",
      "ndc_label_name": "Orkambi TABLET 100-125 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51167080901",
      "ndc_label_name": "Orkambi TABLET 200-125 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185002201",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185002210",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440788020",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040714",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115201102",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040720",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115201101",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440788014",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440788028",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386048028",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440788040",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999004620",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440788060",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999004690",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356098720",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052700",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999004660",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090016900",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040730",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090315001",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017720",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090016902",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090016905",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052702",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052710",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090315000",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386048024",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011704",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012230",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090315005",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052714",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052728",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052730",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017790",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386048026",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162202001",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629156406",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052715",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052760",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017730",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629156405",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629156403",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090016901",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629156409",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011706",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052720",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760081060",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788913803",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015815",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629156404",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052742",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011707",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011709",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760081030",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017772",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788915006",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015830",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017760",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052745",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162202006",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425011702",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919050730",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015820",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187012260",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788915009",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187063260",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959052790",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629156401",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425034001",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015814",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011701",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015860",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011700",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015890",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629156402",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788913806",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011702",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788913809",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011703",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011708",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011705",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629156407",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425034002",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629156408",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629156410",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788915003",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162202005",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425011701",
      "ndc_label_name": "Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00254203273",
      "ndc_label_name": "Orsythia Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00254203291",
      "ndc_label_name": "Orsythia Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090138000",
      "ndc_label_name": "Orsythia Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00254203280",
      "ndc_label_name": "Orsythia Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090430300",
      "ndc_label_name": "Orsythia Tablet 0.1-20 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00766165675",
      "ndc_label_name": "Os-Cal Calcium + D3 Tablet 500-5 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00766165460",
      "ndc_label_name": "Os-Cal Calcium + D3 Tablet 500-5 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00088165475",
      "ndc_label_name": "Os-Cal Calcium + D3 Tablet 500-5 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00088166301",
      "ndc_label_name": "Os-Cal Tablet Chewable 500-15 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00766166310",
      "ndc_label_name": "Os-Cal Tablet Chewable 500-15 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68180067511",
      "ndc_label_name": "Oseltamivir Phosphate CAPSULE 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238126401",
      "ndc_label_name": "Oseltamivir Phosphate CAPSULE 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714081701",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342025666",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219126401",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205035910",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527459113",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205004211",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282070245",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291066610",
      "ndc_label_name": "Oseltamivir Phosphate CAPSULE 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380079701",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722063031",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804001810",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781046813",
      "ndc_label_name": "Oseltamivir Phosphate CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332041310",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710100802",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205041710",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710100902",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205004311",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714081801",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342025766",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527459213",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205036010",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219126501",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205068010",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282070345",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722063131",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781046913",
      "ndc_label_name": "Oseltamivir Phosphate CAPSULE 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332041410",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380079801",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238126501",
      "ndc_label_name": "Oseltamivir Phosphate CAPSULE 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180067611",
      "ndc_label_name": "Oseltamivir Phosphate CAPSULE 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342025866",
      "ndc_label_name": "Oseltamivir Phosphate CAPSULE 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722063231",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527459313",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291066410",
      "ndc_label_name": "Oseltamivir Phosphate CAPSULE 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781047013",
      "ndc_label_name": "Oseltamivir Phosphate CAPSULE 75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090623900",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090563100",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180067711",
      "ndc_label_name": "Oseltamivir Phosphate CAPSULE 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090371800",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700079310",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380079901",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806055501",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272600",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219126601",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812201",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205039710",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002138701",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332041510",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094005061",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090465000",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090609900",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094005059",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238126601",
      "ndc_label_name": "Oseltamivir Phosphate CAPSULE 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205061710",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406601",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825901",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788830901",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788710601",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090734700",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883101",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804018010",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282070445",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710101002",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205020610",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205010710",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205004411",
      "ndc_label_name": "Oseltamivir Phosphate Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090461300",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788760006",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527513762",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291056760",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781038426",
      "ndc_label_name": "Oseltamivir Phosphate SUSPENSION RECONSTITUTED 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812306",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093818064",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205006078",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651059760",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788832106",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380087975",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090334500",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090418800",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238127306",
      "ndc_label_name": "Oseltamivir Phosphate SUSPENSION RECONSTITUTED 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241013909",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090734600",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72516002901",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710116506",
      "ndc_label_name": "Oseltamivir Phosphate SUSPENSION RECONSTITUTED 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180067801",
      "ndc_label_name": "Oseltamivir Phosphate SUSPENSION RECONSTITUTED 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282073952",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097090443",
      "ndc_label_name": "Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55513013728",
      "ndc_label_name": "Otezla Tablet 30 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513013760",
      "ndc_label_name": "Otezla Tablet 30 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513036955",
      "ndc_label_name": "Otezla Tablet Therapy Pack 10 & 20 & 30 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672529304",
      "ndc_label_name": "Ovide LOTION 0.5 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634080860",
      "ndc_label_name": "Oxaprozin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440788530",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080015",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080021",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185014105",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185014101",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080045",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440788591",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289060120",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080014",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080020",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080024",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440788520",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080028",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289060130",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111017001",
      "ndc_label_name": "Oxaprozin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760009214",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080060",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238112001",
      "ndc_label_name": "Oxaprozin TABLET 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080040",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440788560",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080030",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919067360",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289060160",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760020314",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111017005",
      "ndc_label_name": "Oxaprozin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335229501",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135017660",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440788590",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267040745",
      "ndc_label_name": "Oxaprozin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629134504",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017830",
      "ndc_label_name": "Oxaprozin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760038214",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267040730",
      "ndc_label_name": "Oxaprozin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267040714",
      "ndc_label_name": "Oxaprozin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629872401",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080001",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267040760",
      "ndc_label_name": "Oxaprozin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267040720",
      "ndc_label_name": "Oxaprozin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629134503",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629134502",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189007760",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70332031001",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162105106",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080042",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189059560",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629134505",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70332031002",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080090",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804026160",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762600201",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017860",
      "ndc_label_name": "Oxaprozin TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629134501",
      "ndc_label_name": "Oxaprozin Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544011760",
      "ndc_label_name": "Oxazepam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440799530",
      "ndc_label_name": "Oxazepam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440799591",
      "ndc_label_name": "Oxazepam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440799560",
      "ndc_label_name": "Oxazepam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228206710",
      "ndc_label_name": "Oxazepam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544011770",
      "ndc_label_name": "Oxazepam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584081201",
      "ndc_label_name": "Oxazepam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315091101",
      "ndc_label_name": "Oxazepam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440799590",
      "ndc_label_name": "Oxazepam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440799550",
      "ndc_label_name": "Oxazepam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817029010",
      "ndc_label_name": "Oxazepam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544011753",
      "ndc_label_name": "Oxazepam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356017020",
      "ndc_label_name": "Oxazepam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584081211",
      "ndc_label_name": "Oxazepam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544011730",
      "ndc_label_name": "Oxazepam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440799690",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071046090",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817029110",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440799660",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440799630",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228206910",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026830",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440799650",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959083790",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315091201",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584081311",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026853",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063930",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584081301",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063953",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440799691",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026860",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063960",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544026870",
      "ndc_label_name": "Oxazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353098030",
      "ndc_label_name": "Oxazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440799760",
      "ndc_label_name": "Oxazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440799790",
      "ndc_label_name": "Oxazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440799730",
      "ndc_label_name": "Oxazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440799750",
      "ndc_label_name": "Oxazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440799791",
      "ndc_label_name": "Oxazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228207310",
      "ndc_label_name": "Oxazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007430",
      "ndc_label_name": "Oxazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584081401",
      "ndc_label_name": "Oxazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007460",
      "ndc_label_name": "Oxazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817029210",
      "ndc_label_name": "Oxazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584081411",
      "ndc_label_name": "Oxazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315091301",
      "ndc_label_name": "Oxazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054019959",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722068725",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135084124",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268064911",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383031284",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781627043",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162064978",
      "ndc_label_name": "OXcarbazepine SUSPENSION 300 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452012550",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094012362",
      "ndc_label_name": "OXcarbazepine SUSPENSION 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806060022",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094012359",
      "ndc_label_name": "OXcarbazepine SUSPENSION 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162208802",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135084154",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135079841",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999084124",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033011305",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999084145",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268064912",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033011330",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135084145",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603025201",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268064930",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877053258",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377011711",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888007414",
      "ndc_label_name": "OXcarbazepine Suspension 300 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268067911",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084084501",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722002305",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756018388",
      "ndc_label_name": "OXcarbazepine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865028305",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904726261",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991005305",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991005301",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991029201",
      "ndc_label_name": "OXcarbazepine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462013701",
      "ndc_label_name": "OXcarbazepine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687071101",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629381603",
      "ndc_label_name": "OXcarbazepine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888046201",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722002301",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991029205",
      "ndc_label_name": "OXcarbazepine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865028301",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700086860",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888046202",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687071111",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189033960",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429006105",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268067915",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429006101",
      "ndc_label_name": "OXcarbazepine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559022001",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756018313",
      "ndc_label_name": "OXcarbazepine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629381601",
      "ndc_label_name": "OXcarbazepine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756018318",
      "ndc_label_name": "OXcarbazepine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008701",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629381602",
      "ndc_label_name": "OXcarbazepine TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084084511",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205041190",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335050501",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205041160",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008705",
      "ndc_label_name": "OXcarbazepine Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991005405",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991005401",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722002405",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722002401",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056930",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991029305",
      "ndc_label_name": "OXcarbazepine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090257300",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904726361",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072201",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991029301",
      "ndc_label_name": "OXcarbazepine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629207501",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154819800",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603027101",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162159401",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268068011",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268068015",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559022105",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072211",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629498703",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429006201",
      "ndc_label_name": "OXcarbazepine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008805",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559022101",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009001",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429006205",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603027102",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756018413",
      "ndc_label_name": "OXcarbazepine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162159405",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756018488",
      "ndc_label_name": "OXcarbazepine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865028401",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756018418",
      "ndc_label_name": "OXcarbazepine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888046001",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629918601",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804020972",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629498702",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629498701",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009003",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085311",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335254801",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085301",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008801",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462013801",
      "ndc_label_name": "OXcarbazepine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865028405",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009002",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888046002",
      "ndc_label_name": "OXcarbazepine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268068111",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268068115",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904726461",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429006305",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722002505",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991005505",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722002501",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429006301",
      "ndc_label_name": "OXcarbazepine TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991029401",
      "ndc_label_name": "OXcarbazepine TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756018518",
      "ndc_label_name": "OXcarbazepine TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991005501",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008901",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991029405",
      "ndc_label_name": "OXcarbazepine TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073301",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756018588",
      "ndc_label_name": "OXcarbazepine TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786606",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756018513",
      "ndc_label_name": "OXcarbazepine TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073311",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084086701",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888046101",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559022205",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559022201",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865028501",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335014401",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786603",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629683402",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462013901",
      "ndc_label_name": "OXcarbazepine TABLET 600 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603027201",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786609",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084086711",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008905",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335014402",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865028505",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603027202",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888046102",
      "ndc_label_name": "OXcarbazepine Tablet 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135061001",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291063450",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135061005",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729031801",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291063401",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090465800",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063079090",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440800530",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241015604",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090430700",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241015608",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729031816",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162037250",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062815",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090667300",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028460",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028430",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025601",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090535300",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062811",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025605",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175027141",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175027137",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353076941",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980021001",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452012020",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610034730",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135050890",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335169003",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980021005",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189013230",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162037210",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804009530",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610034760",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084061021",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084061011",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789041490",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789004990",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003101",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003105",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729031901",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025701",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062913",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440800630",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241015704",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452012120",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135061101",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162037310",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062911",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135050990",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175027237",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003205",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291063501",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980021101",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175027241",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003201",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032216",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135060901",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729031701",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904657004",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904657006",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241015504",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904657061",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291063301",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729031716",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090684001",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028230",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028260",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135060905",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028530",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090582201",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028553",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241015508",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175027041",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062715",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980020905",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291063350",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028560",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090684000",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268062711",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028253",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090582200",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025505",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084048011",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175027037",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739054833",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980020901",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084048001",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028280",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162037150",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189013130",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084048065",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452011920",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003001",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135050790",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888003005",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162037110",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382025501",
      "ndc_label_name": "Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603149158",
      "ndc_label_name": "Oxybutynin Chloride SYRUP 5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291045650",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440800430",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832003801",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603497528",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "14539065301",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603497521",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904282161",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064010",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353036792",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702020110",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832003889",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832003800",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155081010",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603497532",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702020101",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353097880",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090462203",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702020150",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904702761",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832003850",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353097860",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832003810",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291091450",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629135401",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090663803",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085160",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155081001",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064001",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090619903",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085190",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353036730",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629224401",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090696700",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063093130",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353036753",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135064005",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090663800",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090031800",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353097892",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056953",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817026010",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353036780",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090462201",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "14539065305",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090696601",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090031801",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090619900",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954000510",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817026050",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353097853",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067001",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "14539065310",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111045603",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090031803",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090663801",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335051903",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629135402",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090462200",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629135403",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155081005",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067011",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090204900",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629135405",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335051905",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629135404",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090696603",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899604",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085101",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016201",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090204901",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778509",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335051908",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899601",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407009901",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267064293",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353036760",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380078108",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090204903",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788814109",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090696600",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980043150",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187074930",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056992",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090776600",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267064290",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090619901",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335051901",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111045602",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267101600",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629224601",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315018205",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187074990",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788640220",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111045601",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335051904",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899603",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056960",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016202",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335051906",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980043101",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778502",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407009905",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027753",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267064230",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315018201",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016203",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086080",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267064291",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027792",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629224501",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039492",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084040001",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954000520",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056980",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789041790",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778501",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189013030",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899602",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086030",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778506",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335051907",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084040011",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049060",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315018210",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027760",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980043110",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039453",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027730",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789041730",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778503",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039460",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954000530",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005112",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086060",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335051902",
      "ndc_label_name": "Oxybutynin Chloride TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005152",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027780",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086053",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005113",
      "ndc_label_name": "Oxybutynin Chloride Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054039041",
      "ndc_label_name": "OxyCODONE HCl SOLUTION 5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121483905",
      "ndc_label_name": "oxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121482750",
      "ndc_label_name": "OxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121483940",
      "ndc_label_name": "oxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722019050",
      "ndc_label_name": "OxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950035450",
      "ndc_label_name": "oxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121482705",
      "ndc_label_name": "OxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054039063",
      "ndc_label_name": "OxyCODONE HCl SOLUTION 5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121482740",
      "ndc_label_name": "OxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629117401",
      "ndc_label_name": "oxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904682894",
      "ndc_label_name": "OxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432070605",
      "ndc_label_name": "oxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930002243",
      "ndc_label_name": "OxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904682892",
      "ndc_label_name": "OxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383096134",
      "ndc_label_name": "oxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687040677",
      "ndc_label_name": "oxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406855605",
      "ndc_label_name": "OxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752013614",
      "ndc_label_name": "oxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687040667",
      "ndc_label_name": "oxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950035405",
      "ndc_label_name": "OxyCODONE HCl SOLUTION 5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904667840",
      "ndc_label_name": "OxyCODONE HCl SOLUTION 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752013610",
      "ndc_label_name": "oxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950035455",
      "ndc_label_name": "OxyCODONE HCl SOLUTION 5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559015116",
      "ndc_label_name": "OxyCODONE HCl SOLUTION 5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210401",
      "ndc_label_name": "OxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950035445",
      "ndc_label_name": "OxyCODONE HCl SOLUTION 5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689040101",
      "ndc_label_name": "oxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689040316",
      "ndc_label_name": "oxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689040150",
      "ndc_label_name": "oxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174902",
      "ndc_label_name": "oxyCODONE HCl Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664037088",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406851001",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356083990",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356083930",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702005650",
      "ndc_label_name": "OxyCODONE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858000201",
      "ndc_label_name": "OxyCODONE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858000210",
      "ndc_label_name": "OxyCODONE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702005601",
      "ndc_label_name": "OxyCODONE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071027030",
      "ndc_label_name": "OxyCODONE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406851062",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806000601",
      "ndc_label_name": "OxyCODONE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133502",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429051701",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084096801",
      "ndc_label_name": "OxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189009490",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629460603",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760095530",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629460601",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760095560",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133503",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335142204",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382079401",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919044460",
      "ndc_label_name": "OxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380026001",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162004810",
      "ndc_label_name": "OxyCODONE HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629460604",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189009430",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084096811",
      "ndc_label_name": "OxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133506",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133509",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189063260",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189063230",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189063290",
      "ndc_label_name": "oxyCODONE HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406851501",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000801",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700017430",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760095690",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406851562",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722091705",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904718061",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406851523",
      "ndc_label_name": "OxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722091701",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858000301",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760095630",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084097501",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107005601",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781026405",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000850",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012960",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806000701",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781026401",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629852601",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094000561",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012990",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919065960",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629192701",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919065990",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012902",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700017490",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380026101",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061460",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700017460",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071045390",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071045360",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629888902",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012930",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760095760",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335141301",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865012801",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919065930",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061490",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084097511",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629192801",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664018788",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382079501",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133601",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335141304",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082030",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061430",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429051901",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629888904",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760095660",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162004950",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082090",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094000559",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629888901",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162004910",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071045381",
      "ndc_label_name": "OxyCODONE HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335141303",
      "ndc_label_name": "oxyCODONE HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702005750",
      "ndc_label_name": "OxyCODONE HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664037188",
      "ndc_label_name": "oxyCODONE HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162005010",
      "ndc_label_name": "OxyCODONE HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406852001",
      "ndc_label_name": "oxyCODONE HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702005701",
      "ndc_label_name": "OxyCODONE HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061330",
      "ndc_label_name": "oxyCODONE HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858000401",
      "ndc_label_name": "OxyCODONE HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806000901",
      "ndc_label_name": "OxyCODONE HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700050930",
      "ndc_label_name": "oxyCODONE HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052001",
      "ndc_label_name": "oxyCODONE HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382079601",
      "ndc_label_name": "oxyCODONE HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380026201",
      "ndc_label_name": "oxyCODONE HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406853062",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000950",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858000501",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629889002",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107005701",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406853001",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013030",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013060",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722091805",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722091801",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919067130",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071045490",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806000801",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406853023",
      "ndc_label_name": "OxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071045460",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664022488",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071045492",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781026505",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162005110",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084098301",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999085105",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000901",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071045488",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629193001",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013090",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429052101",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382079701",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335067704",
      "ndc_label_name": "OxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004860",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781026501",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181201",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335141402",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629889001",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380026301",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335141404",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181200",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162005150",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013002",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865012901",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071045491",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919067160",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335067701",
      "ndc_label_name": "OxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629192901",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335067702",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071045481",
      "ndc_label_name": "OxyCODONE HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084098311",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335141401",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133703",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133706",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133709",
      "ndc_label_name": "oxyCODONE HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858000101",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356045330",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406055201",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406055262",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702001801",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406055223",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013190",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904696661",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063040",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806000501",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702001850",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107005501",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356045390",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781026301",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011501",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999089921",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999089960",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781026305",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999089915",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858000110",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429051601",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013150",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335011502",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382079301",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999089990",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162004750",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013130",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999089901",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082190",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664022388",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335098109",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335136103",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013102",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181101",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760095430",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999089930",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380025901",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335136102",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162004710",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959013160",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082130",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061860",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084035401",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760095460",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133406",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335142103",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084035411",
      "ndc_label_name": "OxyCODONE HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181102",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335142101",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133402",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133409",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133403",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162181100",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061830",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189009530",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189061130",
      "ndc_label_name": "oxyCODONE HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722019405",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527167105",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406052301",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702018701",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527167101",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904709561",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959011960",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406052305",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959011930",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722019401",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702018750",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722095101",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598054701",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107004605",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049601",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406052323",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049690",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356080130",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356080160",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436298302",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268064611",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722095105",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049614",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406052362",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629774803",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858010450",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356080190",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049615",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746020405",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436298301",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760089960",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107004601",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629774805",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598054705",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858010401",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097060",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049621",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097090",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061260",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781023001",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629782601",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959011920",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781023005",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700098390",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097001",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760096560",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919087160",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781023063",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071034410",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959011990",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999085405",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061230",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097030",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043760",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187072130",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999085415",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335142001",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746020401",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959011902",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919087130",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187072160",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919087190",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071034460",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268064615",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335142002",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049630",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760027660",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071034481",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082360",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082330",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335103601",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049660",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930004752",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919087172",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760089930",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335103605",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071034490",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68308048047",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020901",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097021",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039730",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187036360",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061290",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335142005",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205034760",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205048660",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020930",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760089990",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020990",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187072190",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071034491",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335210603",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335014605",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335014603",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020960",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760096590",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420032301",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629194201",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335218202",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042630",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335210605",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335142003",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420032330",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043790",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133905",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629950101",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133903",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042672",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420032360",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189025530",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039760",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629190701",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042690",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850062301",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629190801",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420032305",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629395310",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071034420",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335014601",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420032390",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930004712",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071034430",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133906",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071034440",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162133909",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071034492",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042660",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084071001",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084071011",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010067001",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335103603",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189025560",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 10-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406051205",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440800210",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702018550",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440800291",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904709361",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440800204",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406051201",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406051262",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406051223",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722019205",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107004405",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440800293",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261019615",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702018501",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440800206",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440800230",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440800212",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722094901",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722019201",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527166905",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858010250",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781019601",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999085290",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858010201",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440800215",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781019605",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722094905",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107004401",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999085230",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436391305",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436020305",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268064415",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440800220",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436391301",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261019620",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261019610",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436391302",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049860",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959055690",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959055630",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440800294",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049815",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999085214",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261019630",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043230",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760089730",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746020305",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959055660",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527166901",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700065824",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999085260",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700065801",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043260",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052490",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687064201",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746020301",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268064411",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700065830",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049821",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700065856",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061460",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061430",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919024890",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760089760",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436020302",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700065860",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049830",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687064211",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187040620",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010066801",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043290",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187071930",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959055602",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760027460",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049856",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082460",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187071912",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189025790",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082410",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098410",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049814",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629306610",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700065820",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082490",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629191001",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035730",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071015891",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071015830",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049824",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629888804",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700065821",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850062101",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629888801",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420032105",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205032960",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071015890",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049890",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071015810",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919024830",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205032928",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071015812",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420032190",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121606",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071022430",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187040615",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071015840",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061490",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205032930",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071015820",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071015906",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121607",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420013630",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187098430",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205032910",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082430",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420032130",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071015860",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021607",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335967402",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149202",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629190901",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149205",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629782401",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149208",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121608",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335204102",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930004552",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335204106",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021608",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930004512",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071022420",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189025730",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189025760",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420032160",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035760",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039830",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021606",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420032101",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035790",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865011401",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149206",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189039860",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335204108",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406052205",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406052201",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722019305",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406052262",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598054601",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702018601",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702018650",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107004501",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406052223",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904709461",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268064515",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722019301",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999085301",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598054605",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107004505",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722095005",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858010350",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722095001",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700096730",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268064511",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700096760",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781022901",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47781022905",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858010301",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959055490",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436298201",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700098460",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049728",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083530",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049760",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959055402",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999085340",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049730",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959055430",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700098490",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700096790",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335147202",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049790",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700098430",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436298202",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700096728",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629406810",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760096490",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760089830",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335195906",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64850062201",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760096460",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959055460",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760089860",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036860",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629191201",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930004612",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335195908",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071034230",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335147204",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760096430",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162020750",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189037530",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071034260",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420032290",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036830",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010066901",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335195907",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919041260",
      "ndc_label_name": "Oxycodone-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084069901",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420032205",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084069911",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629191101",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189037560",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335195904",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189025630",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629194301",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335147203",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189037590",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68308047547",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162020710",
      "ndc_label_name": "Oxycodone-Acetaminophen TABLET 7.5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420032230",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335147201",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420032260",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930004652",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335195902",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189025672",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335031603",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865011501",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189025660",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420032201",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036890",
      "ndc_label_name": "oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54629016801",
      "ndc_label_name": "Oyster Shell Calcium/D Tablet 250-3.125 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055636",
      "ndc_label_name": "Oyster Shell Calcium/D Tablet 250-3.125 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292050026",
      "ndc_label_name": "Oyster Shell Calcium/D Tablet 250-3.125 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629068202",
      "ndc_label_name": "Oyster Shell Calcium/D Tablet 250-3.125 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205008387",
      "ndc_label_name": "Oyster Shell Calcium/D Tablet 500-10 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845007551",
      "ndc_label_name": "Oyster Shell Calcium/D Tablet 500-10 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205008378",
      "ndc_label_name": "Oyster Shell Calcium/D Tablet 500-10 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353040065",
      "ndc_label_name": "Oyster Shell Calcium/D Tablet 500-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62107007506",
      "ndc_label_name": "Oyster Shell Calcium/D Tablet 500-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055535",
      "ndc_label_name": "Oyster Shell Calcium/D Tablet 500-5 MG-MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00169413212",
      "ndc_label_name": "Ozempic (0.25 or 0.5 MG/DOSE) Solution Pen-Injector 2 MG/1.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00169413211",
      "ndc_label_name": "Ozempic (0.25 or 0.5 MG/DOSE) Solution Pen-Injector 2 MG/1.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00169418113",
      "ndc_label_name": "Ozempic (0.25 or 0.5 MG/DOSE) Solution Pen-Injector 2 MG/3ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00169413602",
      "ndc_label_name": "Ozempic (1 MG/DOSE) Solution Pen-Injector 2 MG/1.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00169413001",
      "ndc_label_name": "Ozempic (1 MG/DOSE) Solution Pen-Injector 4 MG/3ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00169413013",
      "ndc_label_name": "Ozempic (1 MG/DOSE) Solution Pen-Injector 4 MG/3ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090594900",
      "ndc_label_name": "Ozempic (1 MG/DOSE) Solution Pen-Injector 4 MG/3ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00169477212",
      "ndc_label_name": "Ozempic (2 MG/DOSE) Solution Pen-Injector 8 MG/3ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00169477211",
      "ndc_label_name": "Ozempic (2 MG/DOSE) Solution Pen-Injector 8 MG/3ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090605100",
      "ndc_label_name": "Ozempic (2 MG/DOSE) Solution Pen-Injector 8 MG/3ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856016601",
      "ndc_label_name": "Pain Relief Childrens Elixir 325 MG/10.15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37205055662",
      "ndc_label_name": "Pain Relief Cold PE Day TABLET 15-5-325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00591369230",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241027630",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10147095103",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335074483",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332080330",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714086601",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722031730",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27808022201",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367043230",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43975034903",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291091530",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162028003",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72819015703",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180052306",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180052406",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904693561",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591369330",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714086701",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378397993",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27808022301",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687045901",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722031830",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367043330",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10147095203",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72819015803",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291091630",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241027730",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42292002601",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687045911",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162028103",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332080430",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42292002620",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335076583",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43975035003",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27808022401",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591369430",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10147095303",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904693661",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378398093",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291091730",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241027830",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714086801",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722031930",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43975035103",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42292002701",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42292002720",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335076683",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687047011",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687047001",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72819015903",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180052506",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332080530",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367043430",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162028203",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27808022501",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591369530",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42292005501",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162028303",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241027930",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714086901",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378398193",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904693761",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722032030",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367043530",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10147095403",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335076783",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291091830",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332080630",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42292005505",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68180052606",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43975035203",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72819016003",
      "ndc_label_name": "Paliperidone ER Tablet Extended Release 24 Hour 9 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904745861",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090579300",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668009605",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268058511",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407024990",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378668899",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378668877",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353091609",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090185001",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700079030",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722071290",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436009602",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407037490",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668009690",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090141500",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090579301",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268058515",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072511",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760015160",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760071230",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407061290",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090185000",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090141501",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090579302",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436071202",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013460",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760063960",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760071260",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919080660",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063611",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063615",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058501",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436810202",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013490",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187083760",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135053390",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335166701",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760057460",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111033290",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760057430",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700079060",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063530",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788850501",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162063609",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865022990",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175061846",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058511",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187083160",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687072501",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187083730",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788850503",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779809",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027801",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187004230",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919013430",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187083710",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000590",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187083790",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788850506",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189005660",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027803",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862055999",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779803",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862055990",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518178801",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980067609",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010019009",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189005690",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425040601",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993006785",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610034009",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779808",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335029101",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779801",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010309",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008503",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425040603",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779806",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610041609",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788850508",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610034029",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065942",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011230",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509133209",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055203",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788850509",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189005630",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610034017",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011260",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425040602",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603017701",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065909",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011290",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048109",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509133203",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017903",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017902",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008003430",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509163603",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509163609",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027802",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055201",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009001090",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509163606",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425055202",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008003460",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509133206",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722071390",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668042990",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904647461",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378668910",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378668977",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291076510",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668042905",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034309",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033860",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722071310",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668042930",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440801503",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378668999",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002730",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033809",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034353",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033879",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002780",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573042851",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35573042880",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904687045",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090110001",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034330",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353056980",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034380",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033853",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002753",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090579400",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291076590",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090309500",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353073609",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090110000",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353056930",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353056953",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033830",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407061310",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002760",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090309501",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090751200",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079005101",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090537800",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353056960",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090229500",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739056410",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033888",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090751201",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063911",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700085030",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090537900",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090229501",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090537801",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162063711",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742015110",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063915",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118043606",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118043603",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407025010",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407025090",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090579401",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071078260",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079005120",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187097490",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073601",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118043609",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700085060",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407061390",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700085090",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70332030102",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154077700",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980067709",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760067930",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073609",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070090",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111033390",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070040",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335142903",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073665",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010019110",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187093890",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760064630",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135053490",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760061330",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919086630",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009930",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187093830",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934010230",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980067710",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919086640",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864408",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070030",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919086690",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009953",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645059654",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065353",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056099",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187065430",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756001912",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162063709",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135053408",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065360",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788632601",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023090",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70332030001",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084081311",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174609",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084081309",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175061743",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174603",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788632606",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013301",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335055102",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645049154",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189051490",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788632608",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175061746",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013303",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854201",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013302",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610009980",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788632603",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603017801",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864409",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187065490",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016201",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70332030002",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016202",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026830",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854208",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865023010",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934014530",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862056090",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864401",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756001990",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016203",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071078230",
      "ndc_label_name": "Pantoprazole Sodium TABLET DELAYED RELEASE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010019109",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009001190",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000360",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788632609",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021202",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934020330",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022780",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854203",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335071502",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335055103",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036430",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854206",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022730",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335071501",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065380",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788854209",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065330",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008630",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162174606",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864403",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009001110",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864406",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335071503",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335142901",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335142902",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022753",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022760",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036453",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036460",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036480",
      "ndc_label_name": "Pantoprazole Sodium Tablet Delayed Release 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83490044004",
      "ndc_label_name": "Pari Baby Conversion Kit",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83490044003",
      "ndc_label_name": "Pari Baby Conversion Kit",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83490044006",
      "ndc_label_name": "Pari Baby Conversion Kit",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50486008284",
      "ndc_label_name": "Pari Expiratory Filter Set DEVICE",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50486008225",
      "ndc_label_name": "Pari Mask Set",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83490078906",
      "ndc_label_name": "PARI SmartMask Baby/Elbow",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50486008271",
      "ndc_label_name": "Pari Soft Plastic Adult Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50486008270",
      "ndc_label_name": "Pari Soft Plastic Ped Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348050132",
      "ndc_label_name": "Paromomycin Sulfate Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155003801",
      "ndc_label_name": "Paromomycin Sulfate Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904567661",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429073490",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378700193",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378700110",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107015430",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440801090",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034709",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440801030",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107015405",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084004411",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018102",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090129700",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107015490",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018103",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959077550",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018101",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090129600",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009716",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090129601",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118009709",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018104",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458099016",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118009703",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034703",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090129701",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767709",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268064011",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429073430",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018105",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882901",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767703",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268064015",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505009701",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067109",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959077560",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505009702",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034711",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789037990",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767706",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959077530",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505009704",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610020460",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289003745",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032230",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034750",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187019030",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882906",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767701",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009705",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009706",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429073410",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767708",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289003790",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009710",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882909",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067190",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135054190",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205052730",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739088810",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015060",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882908",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067150",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084004401",
      "ndc_label_name": "PARoxetine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189049230",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882903",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067103",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610034860",
      "ndc_label_name": "PARoxetine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018203",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904567761",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034803",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378700293",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107015530",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107015590",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378700210",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084901",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999063230",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055430",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090085002",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440801190",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055415",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018201",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440801130",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429073510",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084902",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034811",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436393303",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107015599",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071315",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018204",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018202",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919065830",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959077660",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090085001",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289097260",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353071345",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099415",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055445",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544031715",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135054290",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629184003",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090277800",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700037930",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084900",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090085000",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099445",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544031760",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862015599",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862015530",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458098916",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092790",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289097290",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429073530",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034809",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084004501",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544031745",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544031730",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505008302",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739096310",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429073590",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629184002",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959077630",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877703",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505008301",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009801",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919018130",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862015505",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505008304",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267072130",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289097230",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877709",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760039890",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009806",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919018190",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067250",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092730",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084004511",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919018160",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934010730",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629184001",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877708",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919065860",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425033901",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544031753",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009816",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919065890",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067203",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009810",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877701",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009805",
      "ndc_label_name": "PARoxetine HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067209",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877706",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067290",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934066130",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335067502",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788907403",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425033902",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788907406",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067210",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425033903",
      "ndc_label_name": "PARoxetine HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135054390",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440801290",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378700310",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018301",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429073690",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378700393",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034909",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107015699",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009905",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505008402",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440801230",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018302",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084004601",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107015690",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268064215",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034903",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788741008",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067303",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107015630",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090598700",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067309",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268064211",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084004611",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034911",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018303",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458098816",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919051230",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009906",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009916",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429073630",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024360",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429073610",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788741001",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788741003",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505008401",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788741006",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505008404",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788741009",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919059630",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335150601",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382009910",
      "ndc_label_name": "PARoxetine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788741002",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067350",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067390",
      "ndc_label_name": "PARoxetine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107015730",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378700410",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440801315",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440801390",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054460",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378700493",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107015790",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440801330",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018403",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13107015799",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018402",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018401",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526301",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054430",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090092101",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084515",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054445",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084530",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018405",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714018404",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382000106",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547035011",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090092300",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090092100",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187043430",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084545",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268064311",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054415",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788687008",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325600",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090092301",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019830",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382000116",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547035003",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700050330",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325601",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019890",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289005345",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090526300",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268064315",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788687001",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547035009",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429073790",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760050190",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162235809",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118015709",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289005390",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544049230",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067450",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118015703",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135054490",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067403",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789042090",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429073730",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429073710",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505010101",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629334901",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919051330",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505010102",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505010104",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071003430",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788687009",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544049215",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084004701",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084004711",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067409",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382000105",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584067490",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518000300",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335060301",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788687003",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005645",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788687006",
      "ndc_label_name": "PARoxetine HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005615",
      "ndc_label_name": "PARoxetine HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069110120",
      "ndc_label_name": "Paxlovid (150/100) Tablet Therapy Pack 10 x 150 MG & 10 x 100MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069531720",
      "ndc_label_name": "Paxlovid (150/100) Tablet Therapy Pack 10 x 150 MG & 10 x 100MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069110104",
      "ndc_label_name": "Paxlovid (150/100) Tablet Therapy Pack 10 x 150 MG & 10 x 100MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069531702",
      "ndc_label_name": "Paxlovid (150/100) Tablet Therapy Pack 10 x 150 MG & 10 x 100MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069543420",
      "ndc_label_name": "Paxlovid (150/100) Tablet Therapy Pack 10 x 150 MG & 10 x 100MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069543402",
      "ndc_label_name": "Paxlovid (150/100) Tablet Therapy Pack 10 x 150 MG & 10 x 100MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069108530",
      "ndc_label_name": "Paxlovid (300/100) Tablet Therapy Pack 20 x 150 MG & 10 x 100MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069504530",
      "ndc_label_name": "Paxlovid (300/100) Tablet Therapy Pack 20 x 150 MG & 10 x 100MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069108506",
      "ndc_label_name": "Paxlovid (300/100) Tablet Therapy Pack 20 x 150 MG & 10 x 100MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069034506",
      "ndc_label_name": "Paxlovid (300/100) Tablet Therapy Pack 20 x 150 MG & 10 x 100MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069504506",
      "ndc_label_name": "Paxlovid (300/100) Tablet Therapy Pack 20 x 150 MG & 10 x 100MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069034530",
      "ndc_label_name": "Paxlovid (300/100) Tablet Therapy Pack 20 x 150 MG & 10 x 100MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069532103",
      "ndc_label_name": "Paxlovid (300/100) Tablet Therapy Pack 20 x 150 MG & 10 x 100MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069532130",
      "ndc_label_name": "Paxlovid (300/100) Tablet Therapy Pack 20 x 150 MG & 10 x 100MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407087212",
      "ndc_label_name": "PAZOPanib HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82293002210",
      "ndc_label_name": "PAZOPanib HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480418489",
      "ndc_label_name": "PAZOPanib HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291093912",
      "ndc_label_name": "PAZOPanib HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651058208",
      "ndc_label_name": "PAZOPanib HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505477907",
      "ndc_label_name": "PAZOPanib HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304011613",
      "ndc_label_name": "PAZOPanib HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00132010624",
      "ndc_label_name": "Pedia-Lax Liquid 50 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08439123020",
      "ndc_label_name": "Pediatric Mouthpiece",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08439640101",
      "ndc_label_name": "Pediatric Panda Mask",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08439640111",
      "ndc_label_name": "Pediatric Panda Mask",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090252600",
      "ndc_label_name": "PEG 3350 Powder 17 GM/SCOOP Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536105224",
      "ndc_label_name": "PEG 3350 Powder 17 GM/SCOOP Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536105284",
      "ndc_label_name": "PEG 3350 Powder 17 GM/SCOOP Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162215504",
      "ndc_label_name": "PEG 3350 Powder 17 GM/SCOOP Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536105227",
      "ndc_label_name": "PEG 3350 Powder 17 GM/SCOOP Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536105260",
      "ndc_label_name": "PEG 3350 Powder 17 GM/SCOOP Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162215502",
      "ndc_label_name": "PEG 3350 Powder 17 GM/SCOOP Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "64380076921",
      "ndc_label_name": "PEG 3350-KCl-Na Bicarb-NaCl SOLUTION RECONSTITUTED 420 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10572030201",
      "ndc_label_name": "PEG 3350-KCl-Na Bicarb-NaCl SOLUTION RECONSTITUTED 420 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090652100",
      "ndc_label_name": "PEG-3350/Electrolytes Solution Reconstituted 236 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10572010001",
      "ndc_label_name": "PEG-3350/Electrolytes SOLUTION RECONSTITUTED 236 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380076621",
      "ndc_label_name": "PEG-3350/Electrolytes Solution Reconstituted 236 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00085136801",
      "ndc_label_name": "Peg-Intron KIT 50 MCG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69166090901",
      "ndc_label_name": "PEG-Prep Kit 5-210 MG-GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00004036530",
      "ndc_label_name": "Pegasys ProClick Solution Auto-Injector 180 MCG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82154044901",
      "ndc_label_name": "Pegasys Solution 180 MCG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00004035009",
      "ndc_label_name": "Pegasys Solution 180 MCG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00004035730",
      "ndc_label_name": "Pegasys Solution Prefilled Syringe 180 MCG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82154045104",
      "ndc_label_name": "Pegasys Solution Prefilled Syringe 180 MCG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82154045101",
      "ndc_label_name": "Pegasys Solution Prefilled Syringe 180 MCG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093412573",
      "ndc_label_name": "Penicillin V Potassium Solution Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093412574",
      "ndc_label_name": "Penicillin V Potassium Solution Reconstituted 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093412774",
      "ndc_label_name": "Penicillin V Potassium SOLUTION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093412773",
      "ndc_label_name": "Penicillin V Potassium SOLUTION RECONSTITUTED 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959076502",
      "ndc_label_name": "Penicillin V Potassium Solution Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090040800",
      "ndc_label_name": "Penicillin V Potassium Solution Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999033220",
      "ndc_label_name": "Penicillin V Potassium Solution Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090040900",
      "ndc_label_name": "Penicillin V Potassium Solution Reconstituted 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440805506",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999000220",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440805508",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440805540",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440805504",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143983701",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143983710",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093117201",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440805509",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033328",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440805510",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237004099",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440805530",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781120501",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440205540",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093117210",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070440",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002020140",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714023401",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789022301",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781120510",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714023402",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070406",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070420",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999000212",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024540",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090228604",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090337400",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033330",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070428",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090228600",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090342500",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090228602",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090228603",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090330700",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033340",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002020130",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090228700",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090350602",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014628",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090337402",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090350604",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090330701",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014606",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348090028",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036628",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033324",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090337403",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090337404",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014620",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237004001",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090350600",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090342501",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024528",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024520",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090350603",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033320",
      "ndc_label_name": "Penicillin V Potassium Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862017501",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862017599",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267015906",
      "ndc_label_name": "Penicillin V Potassium TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781165510",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440805606",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063055730",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143983601",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093117410",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143983610",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093117401",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440805609",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714023501",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063055740",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063057640",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440805640",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440805630",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440205640",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063078015",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440805628",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063055720",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063057628",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063078006",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714023502",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999005014",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440805604",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090161005",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063055715",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063078028",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063078030",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063078020",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090465206",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999005021",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440805620",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321001",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999005010",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090465202",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063078040",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090161004",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090554302",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090161002",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781165501",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090554304",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090161001",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090465205",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090465201",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090161200",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090554306",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321002",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063055704",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090554305",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090161006",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002020210",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348090540",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321006",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959021330",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959021320",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063055706",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959021328",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321004",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187075630",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064940",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090465100",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237004199",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002020220",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063055728",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002020228",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090465101",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092620",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092630",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090554301",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862017605",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064930",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099528",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237004105",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959021324",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629422901",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788985403",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064928",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862017699",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092640",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099540",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824202",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002020230",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629423601",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090465204",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187075620",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789022201",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003520",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959021310",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788824204",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002020240",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003591",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959021340",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016020",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789022230",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003593",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348090520",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016040",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187004530",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003594",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237004101",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003540",
      "ndc_label_name": "Penicillin V Potassium Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629422801",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862017601",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934003530",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016028",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016030",
      "ndc_label_name": "Penicillin V Potassium TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505003307",
      "ndc_label_name": "Pentoxifylline ER Tablet Extended Release 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904544861",
      "ndc_label_name": "Pentoxifylline ER Tablet Extended Release 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571085601",
      "ndc_label_name": "Pentoxifylline ER Tablet Extended Release 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571085650",
      "ndc_label_name": "Pentoxifylline ER Tablet Extended Release 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954066810",
      "ndc_label_name": "Pentoxifylline ER Tablet Extended Release 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999054224",
      "ndc_label_name": "Pentoxifylline ER Tablet Extended Release 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353012392",
      "ndc_label_name": "Pentoxifylline ER Tablet Extended Release 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002530",
      "ndc_label_name": "Pentoxifylline ER Tablet Extended Release 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954066820",
      "ndc_label_name": "Pentoxifylline ER Tablet Extended Release 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505003308",
      "ndc_label_name": "Pentoxifylline ER Tablet Extended Release 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162211301",
      "ndc_label_name": "Pentoxifylline ER Tablet Extended Release 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505003306",
      "ndc_label_name": "Pentoxifylline ER Tablet Extended Release 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002590",
      "ndc_label_name": "Pentoxifylline ER Tablet Extended Release 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002560",
      "ndc_label_name": "Pentoxifylline ER Tablet Extended Release 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006353750",
      "ndc_label_name": "Pepcid Premixed SOLUTION 20-0.9 MG/50ML-% Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714089701",
      "ndc_label_name": "Permethrin Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472024260",
      "ndc_label_name": "Permethrin Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21922002107",
      "ndc_label_name": "Permethrin Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802026937",
      "ndc_label_name": "Permethrin CREAM 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002095768",
      "ndc_label_name": "Permethrin CREAM 5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090251600",
      "ndc_label_name": "Permethrin Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090314900",
      "ndc_label_name": "Permethrin Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959015906",
      "ndc_label_name": "Permethrin Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090588800",
      "ndc_label_name": "Permethrin Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "84386007360",
      "ndc_label_name": "Permethrin Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788843906",
      "ndc_label_name": "Permethrin Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335289901",
      "ndc_label_name": "Permethrin Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162217106",
      "ndc_label_name": "Permethrin Cream 5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155080201",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591410401",
      "ndc_label_name": "Perphenazine TABLET 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781804901",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084478",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407069701",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603506321",
      "ndc_label_name": "Perphenazine TABLET 16 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382059401",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084490",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084464",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342045111",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629224801",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084430",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084460",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536017001",
      "ndc_label_name": "Perphenazine TABLET 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980029301",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084455",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084472",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084400",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084411",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162239901",
      "ndc_label_name": "Perphenazine Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155079901",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904659961",
      "ndc_label_name": "Perphenazine TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407069401",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781804601",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342044811",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084160",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591410101",
      "ndc_label_name": "Perphenazine TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084130",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084100",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084111",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603506021",
      "ndc_label_name": "Perphenazine TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084164",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536016201",
      "ndc_label_name": "Perphenazine TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084172",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980029001",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084178",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629224901",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162239601",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084155",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382059101",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084190",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162116201",
      "ndc_label_name": "Perphenazine Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781804701",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603506121",
      "ndc_label_name": "Perphenazine TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342044911",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904660061",
      "ndc_label_name": "Perphenazine TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440806060",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162116301",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591410201",
      "ndc_label_name": "Perphenazine TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629225101",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135079990",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980029101",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407069501",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084060201",
      "ndc_label_name": "Perphenazine TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603506128",
      "ndc_label_name": "Perphenazine TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084264",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090291200",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084230",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382059201",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084200",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536016401",
      "ndc_label_name": "Perphenazine TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084260",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155080001",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084272",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629225001",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084278",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084255",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084211",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084290",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084060211",
      "ndc_label_name": "Perphenazine TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162239701",
      "ndc_label_name": "Perphenazine Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603506221",
      "ndc_label_name": "Perphenazine TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440806160",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591410301",
      "ndc_label_name": "Perphenazine TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342045011",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155080101",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536016801",
      "ndc_label_name": "Perphenazine TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904660161",
      "ndc_label_name": "Perphenazine TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603506228",
      "ndc_label_name": "Perphenazine TABLET 8 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781804801",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084060701",
      "ndc_label_name": "Perphenazine TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407069601",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084390",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356009660",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084060711",
      "ndc_label_name": "Perphenazine TABLET 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084364",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084300",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959094060",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084378",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980029201",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162239801",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629225201",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084355",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162116401",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382059301",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084311",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629225301",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084360",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084330",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335289301",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084372",
      "ndc_label_name": "Perphenazine Tablet 8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11763052201",
      "ndc_label_name": "Perry Prenatal Capsule 13.5-0.4 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373055300",
      "ndc_label_name": "Pflex",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "98302014015",
      "ndc_label_name": "Pharmacist Choice Mask Wipes",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00021445072",
      "ndc_label_name": "Phazyme TABLET CHEWABLE 125 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090182100",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090644200",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440807008",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440807001",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440807006",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440807004",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440807018",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090331905",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090331908",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657045001",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135062001",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440807010",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090182105",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440807012",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440807020",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002046306",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090644208",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629912701",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291073790",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192080101",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090328300",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090351908",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090331900",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002046309",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090729108",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866806",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090182108",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090351900",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090328305",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959020210",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629912705",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629202801",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293081001",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804000412",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090644205",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090351905",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436438809",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959020230",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162068110",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629770102",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898501",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804004712",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090729100",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090729105",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118051805",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629770101",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866801",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629770105",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367016204",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099424",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293061101",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959020220",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919021606",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629912704",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788950105",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629912703",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367019101",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798101",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293080101",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629114501",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629912702",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70795124100",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367061101",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016108",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083555",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083506",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959020206",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71186000325",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083500",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083510",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205049512",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099800",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083590",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083520",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002046310",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189051506",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083596",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099824",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205049518",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099812",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099810",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789036206",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205049509",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099855",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189053406",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804019218",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804004720",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004706",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804004718",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099400",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083512",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826011410",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099490",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099412",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099406",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804019212",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083524",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099455",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099420",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099496",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099820",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099890",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099896",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099410",
      "ndc_label_name": "Phenazopyridine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090270800",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440807118",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090252306",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440807103",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192080201",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291073890",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090252307",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090352001",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090695206",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135062101",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012203",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440807106",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090352000",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090252301",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090352004",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090587604",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090695207",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090587601",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012215",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440807120",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357100",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090252304",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090352006",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090587606",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293081101",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090655400",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629114601",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090655406",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090587600",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090695204",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090352007",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090587607",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012212",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090655407",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367061201",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090695100",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090655900",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012204",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090590400",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919018410",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012220",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090695200",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016306",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293061201",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293080201",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367016304",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090655401",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919067810",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012230",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090695201",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083624",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869501",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012206",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934081210",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090655404",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919076210",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009806",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002031509",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099990",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71186000425",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012210",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083620",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012209",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629770202",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629202901",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657045101",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099996",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083655",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919018412",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335118401",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002031506",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016220",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016209",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919009810",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335118405",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099900",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919067809",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335118404",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016206",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788790201",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788953705",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629770203",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335118408",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099924",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016221",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180501",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016310",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205016312",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367019201",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629898601",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180504",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180502",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70795125200",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180508",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083600",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081312",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099912",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162068210",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189052206",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180503",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934024610",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189052210",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099910",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083606",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099920",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869509",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789028809",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180505",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081306",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804012506",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099524",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083690",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335118406",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788953701",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083610",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014809",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180506",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804012509",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099906",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189048706",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180507",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083612",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205099955",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099512",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335180509",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804012510",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826011510",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804001612",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804012512",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205083696",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099506",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099590",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099555",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099510",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099596",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189053006",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189053009",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804001606",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804001610",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099500",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099520",
      "ndc_label_name": "Phenazopyridine HCl Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43386036021",
      "ndc_label_name": "Phenelzine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762011901",
      "ndc_label_name": "Phenelzine Sulfate Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135096205",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121094216",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856150802",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121094205",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121094250",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856017404",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517010716",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811029908",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135096224",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603150858",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517020716",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571067516",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687044867",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54932050181",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687044840",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856150805",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629204901",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856017401",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629239901",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135096247",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016601",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367036716",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367035716",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067167",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033016305",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687067140",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999096205",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367017216",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999096224",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162126802",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033016354",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82983041747",
      "ndc_label_name": "PHENobarbital Elixir 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999096207",
      "ndc_label_name": "PHENobarbital Elixir 30 MG/7.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121188407",
      "ndc_label_name": "PHENobarbital Elixir 30 MG/7.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135096223",
      "ndc_label_name": "PHENobarbital Elixir 30 MG/7.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999096223",
      "ndc_label_name": "PHENobarbital Elixir 30 MG/7.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121188450",
      "ndc_label_name": "PHENobarbital Elixir 30 MG/7.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135096207",
      "ndc_label_name": "PHENobarbital Elixir 30 MG/7.5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121282615",
      "ndc_label_name": "PHENobarbital Elixir 60 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999096222",
      "ndc_label_name": "PHENobarbital Elixir 60 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135096215",
      "ndc_label_name": "PHENobarbital Elixir 60 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999096215",
      "ndc_label_name": "PHENobarbital Elixir 60 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135096222",
      "ndc_label_name": "PHENobarbital Elixir 60 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121282650",
      "ndc_label_name": "PHENobarbital Elixir 60 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143145805",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517069401",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143145801",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030350",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571066950",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629204701",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517069405",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293069405",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571066901",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085111",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030310",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057810",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085172",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057801",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517075801",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629204801",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293069401",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099960",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085130",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085190",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826014350",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367069405",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517075805",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367069401",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085164",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085100",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085178",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099964",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099978",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085155",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826014310",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085160",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162158401",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099900",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099911",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099972",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099930",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099990",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099955",
      "ndc_label_name": "PHENobarbital Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143149501",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030050",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030010",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143149505",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084590",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057101",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293069105",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517075505",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517069101",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367069101",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571067050",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517069105",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826013610",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099600",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629204201",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629204101",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293069101",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517075501",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084511",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367069105",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084500",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057110",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099655",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162158101",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084530",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084555",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099678",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099611",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084564",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084560",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099690",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084572",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099630",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084578",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099660",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826013650",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099664",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099672",
      "ndc_label_name": "PHENobarbital Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571067110",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571067101",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440807901",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517062510",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440807990",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603516532",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603516521",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517011001",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69336011511",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098260",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517062501",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030452",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629228901",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030410",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629240001",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517011010",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367062501",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629103201",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629103301",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367021101",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367021110",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629240101",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739019210",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293062501",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084630",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057201",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084690",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084655",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367062510",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084660",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69336011510",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293062510",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088900",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162157100",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088911",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098255",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084678",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098211",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084664",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057210",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088960",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084600",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088955",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084611",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088990",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162126701",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084672",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826013700",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826013710",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098230",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162116600",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088930",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162126700",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162157101",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098200",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098290",
      "ndc_label_name": "PHENobarbital Tablet 16.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517069201",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143150001",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440808590",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440808530",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440808501",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517069205",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143150005",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367069201",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030110",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440808595",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517075601",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089000",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440808591",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571067250",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099711",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826013850",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629204301",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030150",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571067201",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293069201",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440808592",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999039460",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099755",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089030",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057310",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293069205",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629204401",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089060",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440808594",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057301",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099760",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162158205",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089090",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367069205",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099790",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826013810",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517075605",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162158201",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099764",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099730",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999039430",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099772",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999039490",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089011",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089055",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099700",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099778",
      "ndc_label_name": "PHENobarbital Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904657561",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030510",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603516632",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904657580",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187089590",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517011101",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517011110",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603516621",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367062601",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063095330",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517062601",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517062610",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057401",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293062610",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571067310",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571067301",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084764",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69336011610",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739029410",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030552",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057410",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629103401",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084711",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089111",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162157200",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084700",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367021210",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293062601",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69336011611",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084730",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084760",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089130",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098311",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089190",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084772",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367062610",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367021201",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084778",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826013910",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089155",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826013900",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098390",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089100",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084755",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098355",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084790",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098300",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089160",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098330",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162157201",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098360",
      "ndc_label_name": "PHENobarbital Tablet 32.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517075705",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517069305",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057510",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143145501",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517069301",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030210",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00143145505",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629204601",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367069305",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293069301",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826014010",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629204501",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517075701",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999086700",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571067450",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084872",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099811",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084811",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099864",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057501",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030250",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293069305",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099830",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099860",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571067401",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084830",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099890",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084800",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084855",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367069301",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084860",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084890",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084878",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084864",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826014050",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162158301",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099878",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099800",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099855",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804099872",
      "ndc_label_name": "PHENobarbital Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517062701",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010930",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603516732",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571066701",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629240301",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030610",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603516721",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517062710",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057610",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098411",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517011201",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367021310",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367062701",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098460",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629229001",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571066710",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367062710",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084900",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517011210",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69336011710",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084955",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084972",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057601",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084911",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084978",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089211",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030652",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084930",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089230",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084960",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098400",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084964",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089200",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205084990",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293062701",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089255",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162157301",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089260",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098490",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162126500",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162116700",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162126501",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293062710",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162157300",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826014100",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098430",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629240201",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826014110",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69336011711",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098455",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367021301",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089290",
      "ndc_label_name": "PHENobarbital Tablet 64.8 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293062810",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517011301",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603516821",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629103801",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603516832",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517062810",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293062801",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517011310",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085000",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69336011810",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13517062801",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367062801",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030710",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571066801",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629229101",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811030752",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085030",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085011",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629240401",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367062810",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69336011811",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629103901",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057710",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085060",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085072",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098530",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367021410",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089300",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367021401",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64950057701",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085064",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085090",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089330",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098560",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085055",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826014200",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089355",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205085078",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162157401",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162126601",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089360",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089311",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162116800",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826014210",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205089390",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098511",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098555",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162157400",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098500",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804098590",
      "ndc_label_name": "PHENobarbital Tablet 97.2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536129136",
      "ndc_label_name": "Phenylephrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090560600",
      "ndc_label_name": "Phenylephrine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00378156010",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904741661",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664080888",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904618761",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013192",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135060310",
      "ndc_label_name": "Phenytoin Sodium Extended CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013153",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378156001",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135060301",
      "ndc_label_name": "Phenytoin Sodium Extended CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291077210",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862069299",
      "ndc_label_name": "Phenytoin Sodium Extended CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013160",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090353900",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013175",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013194",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291077201",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208901",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013170",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544051794",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999057400",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672411103",
      "ndc_label_name": "Phenytoin Sodium Extended CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316501",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090353901",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268071911",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090316500",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079090501",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086992",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208900",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162021211",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268071913",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090570000",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002150100",
      "ndc_label_name": "Phenytoin Sodium Extended CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687084101",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079090520",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162164600",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090349900",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544051745",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407098201",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664080818",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002150103",
      "ndc_label_name": "Phenytoin Sodium Extended CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081571",
      "ndc_label_name": "Phenytoin Sodium Extended CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672411101",
      "ndc_label_name": "Phenytoin Sodium Extended CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687084111",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090570001",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544051760",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407098210",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187089130",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629852901",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081572",
      "ndc_label_name": "Phenytoin Sodium Extended CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187089190",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629236901",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154549600",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544051798",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162021250",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862069201",
      "ndc_label_name": "Phenytoin Sodium Extended CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162021210",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544051770",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544051792",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047992",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037601",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047960",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047994",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047998",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084037611",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047970",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086994",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086998",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093498",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093494",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162251400",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093492",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162251401",
      "ndc_label_name": "Phenytoin Sodium Extended Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756029988",
      "ndc_label_name": "Phenytoin Sodium Extended CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756029983",
      "ndc_label_name": "Phenytoin Sodium Extended CAPSULE 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756043288",
      "ndc_label_name": "Phenytoin Sodium Extended CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756043283",
      "ndc_label_name": "Phenytoin Sodium Extended CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762053102",
      "ndc_label_name": "Phenytoin Suspension 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672406902",
      "ndc_label_name": "Phenytoin Suspension 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672406901",
      "ndc_label_name": "Phenytoin Suspension 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432013108",
      "ndc_label_name": "Phenytoin Suspension 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689077508",
      "ndc_label_name": "Phenytoin Suspension 125 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980057301",
      "ndc_label_name": "Phenytoin Tablet Chewable 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687015695",
      "ndc_label_name": "Phenytoin TABLET CHEWABLE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904719907",
      "ndc_label_name": "Phenytoin Tablet Chewable 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687015625",
      "ndc_label_name": "Phenytoin TABLET CHEWABLE 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672414601",
      "ndc_label_name": "Phenytoin TABLET CHEWABLE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400306",
      "ndc_label_name": "Phenytoin Tablet Chewable 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12843056094",
      "ndc_label_name": "Phillips Milk of Magnesia Suspension 800 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "12843034710",
      "ndc_label_name": "Phillips Milk of Magnesia Suspension 800 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904688210",
      "ndc_label_name": "Phytonadione Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714097301",
      "ndc_label_name": "Phytonadione Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066113",
      "ndc_label_name": "Phytonadione Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038194",
      "ndc_label_name": "Phytonadione Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097099907",
      "ndc_label_name": "Phytonadione Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710101401",
      "ndc_label_name": "Phytonadione Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038111",
      "ndc_label_name": "Phytonadione Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291056630",
      "ndc_label_name": "Phytonadione Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710101403",
      "ndc_label_name": "Phytonadione Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714097302",
      "ndc_label_name": "Phytonadione Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238105103",
      "ndc_label_name": "Phytonadione Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097099902",
      "ndc_label_name": "Phytonadione Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682017030",
      "ndc_label_name": "Phytonadione Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282074030",
      "ndc_label_name": "Phytonadione Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066111",
      "ndc_label_name": "Phytonadione Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090626800",
      "ndc_label_name": "Pifeltro Tablet 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090623700",
      "ndc_label_name": "Pifeltro Tablet 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006306901",
      "ndc_label_name": "Pifeltro Tablet 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462005100",
      "ndc_label_name": "Pillow Mask/Adult",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462005110",
      "ndc_label_name": "Pillow Mask/Adult",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462004110",
      "ndc_label_name": "Pillow Mask/Child",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462004100",
      "ndc_label_name": "Pillow Mask/Child",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462003110",
      "ndc_label_name": "Pillow Mask/Pediatric",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462003100",
      "ndc_label_name": "Pillow Mask/Pediatric",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069018101",
      "ndc_label_name": "Pilocarpine HCl Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314020315",
      "ndc_label_name": "Pilocarpine HCl SOLUTION 1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478022312",
      "ndc_label_name": "Pilocarpine HCl Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238174508",
      "ndc_label_name": "Pilocarpine HCl Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314020415",
      "ndc_label_name": "Pilocarpine HCl SOLUTION 2 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478022412",
      "ndc_label_name": "Pilocarpine HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238174608",
      "ndc_label_name": "Pilocarpine HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069019101",
      "ndc_label_name": "Pilocarpine HCl Solution 2 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314020615",
      "ndc_label_name": "Pilocarpine HCl SOLUTION 4 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238174708",
      "ndc_label_name": "Pilocarpine HCl Solution 4 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069020101",
      "ndc_label_name": "Pilocarpine HCl Solution 4 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478022612",
      "ndc_label_name": "Pilocarpine HCl Solution 4 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135068001",
      "ndc_label_name": "Pilocarpine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219592201",
      "ndc_label_name": "Pilocarpine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629209901",
      "ndc_label_name": "Pilocarpine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00115592201",
      "ndc_label_name": "Pilocarpine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268065212",
      "ndc_label_name": "Pilocarpine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527131301",
      "ndc_label_name": "Pilocarpine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162111801",
      "ndc_label_name": "Pilocarpine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228280111",
      "ndc_label_name": "Pilocarpine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629843901",
      "ndc_label_name": "Pilocarpine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574079201",
      "ndc_label_name": "Pilocarpine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084092825",
      "ndc_label_name": "Pilocarpine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135058901",
      "ndc_label_name": "Pilocarpine HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162107801",
      "ndc_label_name": "Pilocarpine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651022401",
      "ndc_label_name": "Pilocarpine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714012101",
      "ndc_label_name": "Pilocarpine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084092895",
      "ndc_label_name": "Pilocarpine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268065211",
      "ndc_label_name": "Pilocarpine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69292026501",
      "ndc_label_name": "Pilocarpine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651022501",
      "ndc_label_name": "Pilocarpine HCl Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00228283711",
      "ndc_label_name": "Pilocarpine HCl TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527140701",
      "ndc_label_name": "Pilocarpine HCl TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714012201",
      "ndc_label_name": "Pilocarpine HCl Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135059001",
      "ndc_label_name": "Pilocarpine HCl TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591294460",
      "ndc_label_name": "Pimecrolimus Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462060965",
      "ndc_label_name": "Pimecrolimus Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162188903",
      "ndc_label_name": "Pimecrolimus Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591294430",
      "ndc_label_name": "Pimecrolimus Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591294487",
      "ndc_label_name": "Pimecrolimus Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682011203",
      "ndc_label_name": "Pimecrolimus Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462060935",
      "ndc_label_name": "Pimecrolimus Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462060994",
      "ndc_label_name": "Pimecrolimus Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682011001",
      "ndc_label_name": "Pimecrolimus Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335298801",
      "ndc_label_name": "Pimecrolimus Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335272601",
      "ndc_label_name": "Pimecrolimus Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682011102",
      "ndc_label_name": "Pimecrolimus Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162189101",
      "ndc_label_name": "Pimecrolimus Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162189006",
      "ndc_label_name": "Pimecrolimus Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11917018294",
      "ndc_label_name": "Pinworm Medicine Suspension 144 (50 Base) MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "13668014090",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714064501",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781542031",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781542010",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093727105",
      "ndc_label_name": "Pioglitazone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093727198",
      "ndc_label_name": "Pioglitazone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093727156",
      "ndc_label_name": "Pioglitazone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781542092",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729002016",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729002010",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904709061",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714064502",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090460500",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668014005",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668014030",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005415",
      "ndc_label_name": "Pioglitazone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237021905",
      "ndc_label_name": "Pioglitazone HCl TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005410",
      "ndc_label_name": "Pioglitazone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042650",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714064503",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638600",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729002015",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005407",
      "ndc_label_name": "Pioglitazone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687039101",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304031190",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291095930",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343005305",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042609",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687039111",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304031130",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291095990",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788641903",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862051230",
      "ndc_label_name": "Pioglitazone HCl TABLET 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638601",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343005330",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090131901",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862051205",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788641909",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042603",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798903",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788641906",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343005390",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798901",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090460501",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862051290",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189029290",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090131900",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237021990",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606057001",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237021930",
      "ndc_label_name": "Pioglitazone HCl TABLET 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135080430",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788641901",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798906",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049560",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606057003",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606057002",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788798909",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049760",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049730",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009010305",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610052230",
      "ndc_label_name": "Pioglitazone HCl Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729002116",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011905",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011930",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093727205",
      "ndc_label_name": "Pioglitazone HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093727256",
      "ndc_label_name": "Pioglitazone HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668011990",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781542131",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093727298",
      "ndc_label_name": "Pioglitazone HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005510",
      "ndc_label_name": "Pioglitazone HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090132000",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729002110",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781542192",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714064601",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714064602",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291096030",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781542110",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005515",
      "ndc_label_name": "Pioglitazone HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687300",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729002115",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904709661",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343005405",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714064603",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090784600",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291096090",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042709",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687400",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090458600",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005507",
      "ndc_label_name": "Pioglitazone HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237022090",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042703",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687090511",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042750",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090458601",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788751406",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090639301",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090132001",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919078190",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090639300",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343005430",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090239001",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919078130",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788751409",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788751401",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187074690",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135080530",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304031230",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189010590",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090687301",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304031205",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606057103",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606057102",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343005490",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335133301",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862051305",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304031290",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237022005",
      "ndc_label_name": "Pioglitazone HCl TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606057101",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011130",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009010405",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237022030",
      "ndc_label_name": "Pioglitazone HCl TABLET 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687090521",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862051330",
      "ndc_label_name": "Pioglitazone HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788751403",
      "ndc_label_name": "Pioglitazone HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781542231",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714064703",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093727356",
      "ndc_label_name": "Pioglitazone HCl TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668012005",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093727305",
      "ndc_label_name": "Pioglitazone HCl TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005607",
      "ndc_label_name": "Pioglitazone HCl TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781542292",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729002215",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714064702",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042809",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781542210",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668012030",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093727398",
      "ndc_label_name": "Pioglitazone HCl TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005615",
      "ndc_label_name": "Pioglitazone HCl TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668012090",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237022130",
      "ndc_label_name": "Pioglitazone HCl TABLET 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729002216",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090132100",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714064701",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729002210",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342005610",
      "ndc_label_name": "Pioglitazone HCl TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032630",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291096150",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304031330",
      "ndc_label_name": "Pioglitazone HCl TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090455600",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304031390",
      "ndc_label_name": "Pioglitazone HCl TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291096130",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042803",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090240101",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090455601",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638401",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547042850",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343005530",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090641201",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090132101",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638400",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237022105",
      "ndc_label_name": "Pioglitazone HCl TABLET 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343005590",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237022190",
      "ndc_label_name": "Pioglitazone HCl TABLET 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090641200",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862051430",
      "ndc_label_name": "Pioglitazone HCl TABLET 45 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135080630",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090240100",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606057202",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862051405",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606057203",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343005505",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189029390",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862051490",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009010505",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606057201",
      "ndc_label_name": "Pioglitazone HCl Tablet 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291095301",
      "ndc_label_name": "Piroxicam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291067401",
      "ndc_label_name": "Piroxicam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002054810",
      "ndc_label_name": "Piroxicam CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959039800",
      "ndc_label_name": "Piroxicam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162129001",
      "ndc_label_name": "Piroxicam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959039860",
      "ndc_label_name": "Piroxicam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033001201",
      "ndc_label_name": "Piroxicam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093075601",
      "ndc_label_name": "Piroxicam CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017601",
      "ndc_label_name": "Piroxicam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959039830",
      "ndc_label_name": "Piroxicam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762014001",
      "ndc_label_name": "Piroxicam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002054820",
      "ndc_label_name": "Piroxicam CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959039810",
      "ndc_label_name": "Piroxicam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021001",
      "ndc_label_name": "Piroxicam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300025501",
      "ndc_label_name": "Piroxicam CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959039820",
      "ndc_label_name": "Piroxicam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629914801",
      "ndc_label_name": "Piroxicam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002054830",
      "ndc_label_name": "Piroxicam CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959039821",
      "ndc_label_name": "Piroxicam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380084206",
      "ndc_label_name": "Piroxicam Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093075705",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440810590",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002038910",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300025605",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033001305",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033001301",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440810560",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093075701",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440810514",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062330",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700069730",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291067750",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090329504",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300025601",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162129105",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291067701",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440810530",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023260",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023220",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291095450",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634093871",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062360",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023221",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291095401",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571017701",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016830",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023230",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023214",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077530",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023209",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380084306",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023207",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077560",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023218",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380084307",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023215",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023290",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002038915",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016828",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023210",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002038930",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016890",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016860",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002038920",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762014501",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629915001",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629914901",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919018830",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162129101",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016814",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016810",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205003230",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267016820",
      "ndc_label_name": "Piroxicam CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205020330",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789021101",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189035060",
      "ndc_label_name": "Piroxicam Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50024092400",
      "ndc_label_name": "Pixel COVID-19 PCR Home Test Kit In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629883201",
      "ndc_label_name": "Podofilox Solution 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574061105",
      "ndc_label_name": "Podofilox Solution 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591320413",
      "ndc_label_name": "Podofilox Solution 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856040201",
      "ndc_label_name": "Poly-Vi-Sol Solution Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00087040265",
      "ndc_label_name": "Poly-Vi-Sol Solution Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "17856040204",
      "ndc_label_name": "Poly-Vi-Sol Solution Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "17856040203",
      "ndc_label_name": "Poly-Vi-Sol Solution Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00087040203",
      "ndc_label_name": "Poly-Vi-Sol Solution Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00087040501",
      "ndc_label_name": "Poly-Vi-Sol/Iron Solution 11 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00087040506",
      "ndc_label_name": "Poly-Vi-Sol/Iron Solution 11 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "17856062504",
      "ndc_label_name": "Poly-Vitamin/Iron Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "17856062503",
      "ndc_label_name": "Poly-Vitamin/Iron Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "17856063203",
      "ndc_label_name": "Poly-Vitamin/Iron Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "17856062550",
      "ndc_label_name": "Poly-Vitamin/Iron Solution 10 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090165300",
      "ndc_label_name": "Polycin Ointment 500-10000 UNIT/GM Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574402135",
      "ndc_label_name": "Polycin Ointment 500-10000 UNIT/GM Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919011135",
      "ndc_label_name": "Polycin Ointment 500-10000 UNIT/GM Ophthalmic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069031101",
      "ndc_label_name": "Polymyxin B-Trimethoprim Solution 10000-0.1 UNIT/ML-% Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356053610",
      "ndc_label_name": "Polymyxin B-Trimethoprim Solution 10000-0.1 UNIT/ML-% Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090292500",
      "ndc_label_name": "Polymyxin B-Trimethoprim Solution 10000-0.1 UNIT/ML-% Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187083410",
      "ndc_label_name": "Polymyxin B-Trimethoprim SOLUTION 10000-0.1 UNIT/ML-% Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959060910",
      "ndc_label_name": "Polymyxin B-Trimethoprim Solution 10000-0.1 UNIT/ML-% Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478070311",
      "ndc_label_name": "Polymyxin B-Trimethoprim Solution 10000-0.1 UNIT/ML-% Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700010510",
      "ndc_label_name": "Polymyxin B-Trimethoprim Solution 10000-0.1 UNIT/ML-% Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208031510",
      "ndc_label_name": "Polymyxin B-Trimethoprim SOLUTION 10000-0.1 UNIT/ML-% OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60758090810",
      "ndc_label_name": "Polymyxin B-Trimethoprim Solution 10000-0.1 UNIT/ML-% Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090239800",
      "ndc_label_name": "Polymyxin B-Trimethoprim Solution 10000-0.1 UNIT/ML-% Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002086272",
      "ndc_label_name": "Polymyxin B-Trimethoprim SOLUTION 10000-0.1 UNIT/ML-% OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090059800",
      "ndc_label_name": "Polymyxin B-Trimethoprim Solution 10000-0.1 UNIT/ML-% Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314062810",
      "ndc_label_name": "Polymyxin B-Trimethoprim SOLUTION 10000-0.1 UNIT/ML-% OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187063110",
      "ndc_label_name": "Polymyxin B-Trimethoprim Solution 10000-0.1 UNIT/ML-% Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919023310",
      "ndc_label_name": "Polymyxin B-Trimethoprim Solution 10000-0.1 UNIT/ML-% Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919021510",
      "ndc_label_name": "Polymyxin B-Trimethoprim Solution 10000-0.1 UNIT/ML-% Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919071910",
      "ndc_label_name": "Polymyxin B-Trimethoprim SOLUTION 10000-0.1 UNIT/ML-% OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788815201",
      "ndc_label_name": "Polymyxin B-Trimethoprim Solution 10000-0.1 UNIT/ML-% Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189000510",
      "ndc_label_name": "Polymyxin B-Trimethoprim Solution 10000-0.1 UNIT/ML-% Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10267210301",
      "ndc_label_name": "Polysaccharide Iron Forte Capsule 150-25-1 MG-MCG-MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00081079888",
      "ndc_label_name": "Polysporin Ointment 500-10000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "12547023813",
      "ndc_label_name": "Polysporin Ointment 500-10000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00081079887",
      "ndc_label_name": "Polysporin Ointment 500-10000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49999059244",
      "ndc_label_name": "Polysporin Ointment 500-10000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58232040349",
      "ndc_label_name": "Polysporin Ointment 500-10000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50436300101",
      "ndc_label_name": "Polysporin Ointment 500-10000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090300100",
      "ndc_label_name": "Polysporin Ointment 500-10000 UNIT/GM External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "53746054201",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574018101",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904693061",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090746909",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574018105",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547055310",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289021830",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687065311",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59917010305",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547055350",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904754361",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268067111",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291067950",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090344909",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687065321",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629107901",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001039600",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62037056001",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097701",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268067113",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59917010301",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746054210",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51477000111",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382070105",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62037056005",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304009005",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746054205",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304009001",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62037056010",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687065301",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629107904",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010014801",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001061903",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629107903",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180079901",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629107801",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462035701",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62037056090",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005701",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001061900",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629108001",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180079902",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629107902",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000230",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382070101",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001039603",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462035705",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010014805",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005730",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005782",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 10 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180079801",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291067890",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59917010201",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547055210",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629107701",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629107601",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62037055905",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629107702",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382070201",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063097801",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62037055901",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010014701",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005601",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304007801",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789005630",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180079802",
      "ndc_label_name": "Potassium Chloride ER Capsule Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440810960",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440810990",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378456005",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440810991",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440810930",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378456077",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440810992",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629262003",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979022901",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832532210",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574027401",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571084250",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832532211",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574027405",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571084201",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629870001",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380086008",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380086007",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979022903",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629844301",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806042201",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806042205",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862098605",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380086006",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806042210",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862098601",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436000101",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010002101",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382077610",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382077601",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436000103",
      "ndc_label_name": "Potassium Chloride ER Tablet Extended Release 8 MEQ Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121494894",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121094816",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121189650",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904746243",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121494800",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121189600",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121189630",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121189640",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904706146",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121494880",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121494850",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856004803",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033041232",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121494840",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121494815",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033022052",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904706180",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033022051",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904706147",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739016434",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904746273",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904746260",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904706151",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82983041147",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904706187",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033041234",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033041250",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81033041251",
      "ndc_label_name": "Potassium Chloride Solution 10 % Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010007344",
      "ndc_label_name": "Potassium Chloride Solution 40 MEQ/15ML (20%) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72888004213",
      "ndc_label_name": "Potassium Chloride Solution 40 MEQ/15ML (20%) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71656002216",
      "ndc_label_name": "Potassium Chloride Solution 40 MEQ/15ML (20%) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505618506",
      "ndc_label_name": "Potassium Chloride Solution 40 MEQ/15ML (20%) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121284716",
      "ndc_label_name": "Potassium Chloride Solution 40 MEQ/15ML (20%) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603154358",
      "ndc_label_name": "Potassium Chloride Solution 40 MEQ/15ML (20%) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71656002250",
      "ndc_label_name": "Potassium Chloride Solution 40 MEQ/15ML (20%) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43386016901",
      "ndc_label_name": "Potassium Chloride Solution 40 MEQ/15ML (20%) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238145802",
      "ndc_label_name": "Potassium Chloride Solution 40 MEQ/15ML (20%) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571035807",
      "ndc_label_name": "Potassium Chloride Solution 40 MEQ/15ML (20%) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82983041247",
      "ndc_label_name": "Potassium Chloride Solution 40 MEQ/15ML (20%) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268067511",
      "ndc_label_name": "Potassium Chloride Solution 40 MEQ/15ML (20%) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268067512",
      "ndc_label_name": "Potassium Chloride Solution 40 MEQ/15ML (20%) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591272901",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245007111",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "44523041001",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291049901",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543040701",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020330",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407045001",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722013001",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629875901",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086501",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629196601",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452019320",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085032",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085033",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559029101",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382053701",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162175801",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162247701",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335287101",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930004912",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865019201",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162212001",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020301",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162175901",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162212101",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291050001",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162218701",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335289701",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559029201",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591274201",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407045101",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865019301",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020430",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "44523041501",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005012",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722013201",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382053801",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543040801",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162247801",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629196701",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020401",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452019420",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591268201",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 5 MEQ (540 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571086401",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 5 MEQ (540 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42543040601",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 5 MEQ (540 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020201",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 5 MEQ (540 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245007011",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 5 MEQ (540 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722012901",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 5 MEQ (540 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382053601",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 5 MEQ (540 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407044901",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 5 MEQ (540 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930004812",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 5 MEQ (540 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162212201",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 5 MEQ (540 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020230",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 5 MEQ (540 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162247601",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 5 MEQ (540 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865019101",
      "ndc_label_name": "Potassium Citrate ER Tablet Extended Release 5 MEQ (540 MG) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121067616",
      "ndc_label_name": "Potassium Citrate-Citric Acid Solution 1100-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135043547",
      "ndc_label_name": "Potassium Citrate-Citric Acid Solution 1100-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999043505",
      "ndc_label_name": "Potassium Citrate-Citric Acid Solution 1100-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135043524",
      "ndc_label_name": "Potassium Citrate-Citric Acid Solution 1100-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367032116",
      "ndc_label_name": "Potassium Citrate-Citric Acid Solution 1100-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657031216",
      "ndc_label_name": "Potassium Citrate-Citric Acid Solution 1100-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999043524",
      "ndc_label_name": "Potassium Citrate-Citric Acid Solution 1100-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135043505",
      "ndc_label_name": "Potassium Citrate-Citric Acid Solution 1100-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228012610",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668009105",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668009190",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060490",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629504201",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060499",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237018090",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382019610",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429008590",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382019616",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380074605",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462033090",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228012710",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060590",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668009205",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904670461",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668009290",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090219000",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090328000",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687057001",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237018190",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382019710",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687057011",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429008690",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380074705",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060599",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382019716",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462033190",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228012810",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668009390",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090138800",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090221700",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380074805",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058111",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237018290",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668009305",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060690",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090245500",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429008790",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462033290",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058121",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060699",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382019810",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382019816",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380074905",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722090990",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668018405",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060790",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162256909",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668018490",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060799",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228012990",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429008890",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 0.75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237018390",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 0.75 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668009490",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060899",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059221",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059211",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228013010",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060890",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237018490",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668009405",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090335000",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382019910",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462033390",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722091090",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429008990",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382019916",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380075005",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060990",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237018590",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668009590",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090267600",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380075105",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668009505",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228013190",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722091190",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382020016",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429009090",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060999",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382020010",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090781600",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090503600",
      "ndc_label_name": "Pramipexole Dihydrochloride Tablet 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462033490",
      "ndc_label_name": "Pramipexole Dihydrochloride TABLET 1.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904589161",
      "ndc_label_name": "Pravastatin Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815581",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090159400",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815530",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093077110",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815585",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093077198",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714055801",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714055802",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815590",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325800",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291066510",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815560",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356092130",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407088710",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689014002",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000815",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090159401",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458092716",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066511",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135049890",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687016901",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111022990",
      "ndc_label_name": "Pravastatin Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090325801",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000816",
      "ndc_label_name": "Pravastatin Sodium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407088790",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629916201",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016490",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066515",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189005990",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016405",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090385300",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291066590",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070730",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629916202",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629890501",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097078805",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629890401",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687016911",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505016805",
      "ndc_label_name": "Pravastatin Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090385301",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405906",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180048509",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382007005",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335229802",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405909",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135084790",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687088611",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111022905",
      "ndc_label_name": "Pravastatin Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170609",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377004512",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462019505",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84386003190",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180048502",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382007016",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377004514",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505016809",
      "ndc_label_name": "Pravastatin Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462019590",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842506",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335229801",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687088601",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842503",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170603",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842509",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070790",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097078812",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629883301",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335284801",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405903",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335005601",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84386003199",
      "ndc_label_name": "Pravastatin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000915",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815681",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000917",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714055902",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093720110",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815660",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093720198",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815685",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291066710",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714055901",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689014102",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000916",
      "ndc_label_name": "Pravastatin Sodium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815630",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090097500",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090097300",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815690",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090097501",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291066790",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689014105",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090789201",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356091930",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090202500",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771000",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904589261",
      "ndc_label_name": "Pravastatin Sodium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016590",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770901",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063080730",
      "ndc_label_name": "Pravastatin Sodium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458092616",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063044330",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090689800",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458086910",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135049990",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687089701",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090781300",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090202501",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505016909",
      "ndc_label_name": "Pravastatin Sodium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090389800",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090755100",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111023005",
      "ndc_label_name": "Pravastatin Sodium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090097301",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070930",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111023090",
      "ndc_label_name": "Pravastatin Sodium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090389801",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919073190",
      "ndc_label_name": "Pravastatin Sodium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407088810",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066611",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687089711",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090755200",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629916301",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016505",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090755101",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180048602",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407088890",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079045801",
      "ndc_label_name": "Pravastatin Sodium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760042190",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090789300",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629916302",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070990",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770900",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382007105",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505016907",
      "ndc_label_name": "Pravastatin Sodium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079045820",
      "ndc_label_name": "Pravastatin Sodium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919080130",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066615",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180048609",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789014330",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090789200",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777903",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462019605",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462019690",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135084890",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629890901",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382007116",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766103",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687017801",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777906",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821509",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766106",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629890601",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377004614",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404906",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821503",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687017811",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788777909",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842103",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162211400",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404903",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205014930",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842106",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189006030",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842109",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821506",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097078905",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189006090",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404909",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887109",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887103",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009000610",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766109",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84386003290",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377004612",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097078912",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788887106",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934041830",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335290801",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84386003299",
      "ndc_label_name": "Pravastatin Sodium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093720210",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904589361",
      "ndc_label_name": "Pravastatin Sodium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135050090",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093720298",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689014202",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815785",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815730",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815781",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729001015",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291066890",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063080830",
      "ndc_label_name": "Pravastatin Sodium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066715",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689014205",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815790",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815760",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714056001",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729001016",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090420600",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353047445",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407088910",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090614500",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714056002",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729001017",
      "ndc_label_name": "Pravastatin Sodium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090682600",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096445",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066711",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353068545",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458092516",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099430",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356012530",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291066810",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090691100",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090153300",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407088990",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090153301",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070830",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629891101",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063044430",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090614501",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090761200",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090761300",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687019011",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090761201",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135084990",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629916401",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353049645",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111023105",
      "ndc_label_name": "Pravastatin Sodium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111023190",
      "ndc_label_name": "Pravastatin Sodium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016605",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382007205",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458086710",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382007216",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012130",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096460",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687090811",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687019001",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016690",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377004714",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505017007",
      "ndc_label_name": "Pravastatin Sodium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934034430",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170706",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090202400",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377004712",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629891001",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462019790",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029430",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505017009",
      "ndc_label_name": "Pravastatin Sodium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087960",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934016130",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090202401",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069201",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629916402",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029490",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069202",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629883501",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170700",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088445",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090420601",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069204",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180048702",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170701",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088453",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170709",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189006130",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335268701",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079078201",
      "ndc_label_name": "Pravastatin Sodium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162195300",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097079105",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84386003390",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088460",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84386003399",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189006190",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079078220",
      "ndc_label_name": "Pravastatin Sodium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335069203",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170703",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009000790",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687090801",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760042290",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919054690",
      "ndc_label_name": "Pravastatin Sodium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180048709",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462019705",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097079112",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205051630",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335283301",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087945",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087953",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789016130",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009000710",
      "ndc_label_name": "Pravastatin Sodium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815860",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480727010",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815830",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093727098",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093727010",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480727098",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714057001",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714057002",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729001115",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291066910",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689014301",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815890",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111027405",
      "ndc_label_name": "Pravastatin Sodium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291066990",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729001116",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407089010",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084445",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084430",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090580900",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096645",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629891301",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096660",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066811",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111027490",
      "ndc_label_name": "Pravastatin Sodium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407089090",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320400",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090592700",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320401",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097079205",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090580901",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629883601",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180048802",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016705",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919073490",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629750804",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090592701",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162171109",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066812",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382007305",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180048809",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016790",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382007316",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629916501",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505132305",
      "ndc_label_name": "Pravastatin Sodium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84386003490",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135085090",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009000805",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766006",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505132309",
      "ndc_label_name": "Pravastatin Sodium TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766001",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462019805",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629750801",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063745",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629750802",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462019890",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162171104",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087753",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766008",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766003",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629891201",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087760",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629750803",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097079212",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766002",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377004812",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377004813",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610063730",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788766009",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629916502",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087730",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162171102",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087745",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162171103",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011990",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162171105",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84386003499",
      "ndc_label_name": "Pravastatin Sodium Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093406710",
      "ndc_label_name": "Prazosin HCl CAPSULE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135066601",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093406701",
      "ndc_label_name": "Prazosin HCl CAPSULE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815060",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378110110",
      "ndc_label_name": "Prazosin HCl CAPSULE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815094",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090284500",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815090",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378110101",
      "ndc_label_name": "Prazosin HCl CAPSULE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079063001",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904702061",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815092",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090037901",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090194801",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082030",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090569501",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651027199",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332069191",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135066610",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651027101",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700049230",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762531001",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559058010",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919091090",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429097101",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954001950",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079063020",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733509",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993043185",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332069131",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084099601",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756042912",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205027591",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084099611",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289053601",
      "ndc_label_name": "Prazosin HCl CAPSULE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335964805",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733503",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733501",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377006611",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205027590",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282072110",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010008401",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289053660",
      "ndc_label_name": "Prazosin HCl CAPSULE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954001910",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788733506",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954001920",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756042911",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057160",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429097110",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069360",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189043630",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919091060",
      "ndc_label_name": "Prazosin HCl CAPSULE 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189043660",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559058001",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205027599",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282072101",
      "ndc_label_name": "Prazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815194",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093406810",
      "ndc_label_name": "Prazosin HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378230210",
      "ndc_label_name": "Prazosin HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815192",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093406801",
      "ndc_label_name": "Prazosin HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904702161",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762532001",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378230201",
      "ndc_label_name": "Prazosin HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090282800",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135066710",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815190",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651027299",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815130",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332069291",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559058110",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086860",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756043012",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874201",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135066701",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429097201",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353003560",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559058101",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335108501",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079063101",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353003580",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874206",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063026030",
      "ndc_label_name": "Prazosin HCl CAPSULE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429097210",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090307200",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377006711",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069460",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084099711",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651027201",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010008501",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086880",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874203",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084099701",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756043011",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069480",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098080",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954002020",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205027691",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079063120",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335108503",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335231104",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335231101",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098060",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282072210",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205027699",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804002160",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760082130",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282072201",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189054030",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332069231",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804002130",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993043285",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874209",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954002010",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004660",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004680",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098160",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098180",
      "ndc_label_name": "Prazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093406901",
      "ndc_label_name": "Prazosin HCl CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135066869",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093406952",
      "ndc_label_name": "Prazosin HCl CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993043385",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093406905",
      "ndc_label_name": "Prazosin HCl CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815392",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378320525",
      "ndc_label_name": "Prazosin HCl CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378320501",
      "ndc_label_name": "Prazosin HCl CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762535001",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063024830",
      "ndc_label_name": "Prazosin HCl CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440815390",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784906",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135066801",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079063220",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651027301",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079063201",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429097301",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782403",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904702261",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784909",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332069361",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377006811",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687057233",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332069331",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429097325",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784901",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651027325",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788806706",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782406",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189047030",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866003",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559058201",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687057232",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082927",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866001",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081427",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782409",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788782401",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756044011",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788806701",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559058225",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518270502",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788806703",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954002120",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788784903",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205027795",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788806709",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205027791",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788814403",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282072325",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866006",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866009",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010008601",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518188401",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954002110",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282072301",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804008990",
      "ndc_label_name": "Prazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090056100",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60758011910",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090527500",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219255101",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090055900",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959026510",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219255001",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090753900",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090191200",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189005505",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60758011905",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314063710",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748033202",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60219255201",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314063705",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314063715",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959026505",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60758011915",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748033203",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748033204",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959026515",
      "ndc_label_name": "prednisoLONE Acetate Suspension 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121075908",
      "ndc_label_name": "PrednisoLONE Sodium Phosphate SOLUTION 15 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856081503",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121475905",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42799081501",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090158200",
      "ndc_label_name": "PrednisoLONE Sodium Phosphate Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856075902",
      "ndc_label_name": "PrednisoLONE Sodium Phosphate Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090095500",
      "ndc_label_name": "PrednisoLONE Sodium Phosphate Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121475950",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788404602",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70166054905",
      "ndc_label_name": "PrednisoLONE Sodium Phosphate Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856081502",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432021208",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788770802",
      "ndc_label_name": "PrednisoLONE Sodium Phosphate Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856075905",
      "ndc_label_name": "PrednisoLONE Sodium Phosphate SOLUTION 15 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17856081501",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238212209",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121090204",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13925016604",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135033005",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383004004",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135033041",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135033024",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999033005",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999033024",
      "ndc_label_name": "prednisoLONE Sodium Phosphate Solution 5 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090065501",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121088516",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155092751",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527540670",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383004248",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68071153208",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527540668",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121088508",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135025045",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569482700",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33261047501",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090065500",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959062260",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155092752",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090711501",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090711500",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919029108",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33358029108",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788720704",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50383004224",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135025024",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135025037",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999025024",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569482701",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999025045",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135025047",
      "ndc_label_name": "prednisoLONE Solution 15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00054372263",
      "ndc_label_name": "PredniSONE SOLUTION 5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054372250",
      "ndc_label_name": "PredniSONE SOLUTION 5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856372201",
      "ndc_label_name": "PredniSONE SOLUTION 5 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407035501",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603533521",
      "ndc_label_name": "PredniSONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527293037",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054873925",
      "ndc_label_name": "PredniSONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054474125",
      "ndc_label_name": "PredniSONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651048401",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054474131",
      "ndc_label_name": "PredniSONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219170501",
      "ndc_label_name": "PredniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407035510",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746017106",
      "ndc_label_name": "PredniSONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135047090",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527293043",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603533532",
      "ndc_label_name": "PredniSONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162116901",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687084301",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135047018",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629225501",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687084311",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380078206",
      "ndc_label_name": "PredniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135077401",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651048499",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629225401",
      "ndc_label_name": "PredniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629243401",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205008900",
      "ndc_label_name": "PredniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746017110",
      "ndc_label_name": "PredniSONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162169100",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954005620",
      "ndc_label_name": "PredniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954005610",
      "ndc_label_name": "PredniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162116900",
      "ndc_label_name": "predniSONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378064101",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816610",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001729",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054981729",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001720",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001725",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378064110",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816630",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591544210",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135077701",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816612",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527293337",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054981725",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591544201",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816620",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527293341",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291077050",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291078350",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591544205",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904692361",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086628",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356067560",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603533821",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086610",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086630",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086620",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603533832",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356067648",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253204",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086660",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603533828",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090009704",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002801",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090009702",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086640",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086607",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253207",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999002828",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135077710",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090009705",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090009700",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090009707",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090100200",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086650",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520201",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090009801",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086612",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090009800",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090009701",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090702500",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253201",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253200",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090702501",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090260800",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086621",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313701",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313702",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721901",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090260801",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253202",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721802",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721805",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086642",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313704",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313705",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436173005",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721800",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253205",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721807",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736900",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090009708",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565602",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565605",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012610",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736904",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313708",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721808",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736902",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253208",
      "ndc_label_name": "PredniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565607",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565701",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030921",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012642",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090520200",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736905",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407035805",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313700",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090565608",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012605",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348050630",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012660",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090702300",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655041054",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012607",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090313707",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721801",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012612",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651048701",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030940",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721804",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700020821",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012618",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090721900",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736908",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012615",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629225801",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919023510",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736901",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700020860",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012625",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090737101",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436432502",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012621",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644004",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919023540",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090736907",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219170701",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012650",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012640",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407035801",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012630",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816602",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187030040",
      "ndc_label_name": "PredniSONE TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090737100",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760017918",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030912",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030920",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012600",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030900",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009520",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267081204",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407092210",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919023542",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348050605",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687013401",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012637",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030910",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009530",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644009",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012620",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919040430",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760061518",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687013411",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012644",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030915",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934029121",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811602",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030925",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380078407",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919023521",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919040421",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012670",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030932",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934058015",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811605",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746017306",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380078408",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919023530",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561012105",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030914",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348050610",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934083112",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934058010",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219170705",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017120",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187003721",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629225701",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030930",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700020830",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934083115",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934083121",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687091401",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644001",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187030018",
      "ndc_label_name": "PredniSONE TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934058020",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002030935",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746017310",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954005910",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205036228",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687091411",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644003",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187030036",
      "ndc_label_name": "PredniSONE TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934058021",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348050640",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187003720",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954005920",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205042130",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187030021",
      "ndc_label_name": "PredniSONE TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644006",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629225601",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205042121",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651048705",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187030024",
      "ndc_label_name": "PredniSONE TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205042110",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205072940",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187030042",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205036220",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380078406",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205072930",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187030015",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187030027",
      "ndc_label_name": "PredniSONE TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205042124",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081842",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561012101",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205042118",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017115",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081830",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187030028",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561012102",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205072918",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065104",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017121",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081820",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017142",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335046408",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629225901",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629157910",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205072920",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335304501",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017130",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065100",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017148",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065103",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644008",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644007",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205072921",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040110",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017140",
      "ndc_label_name": "PredniSONE TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117201",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644002",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065106",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811603",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811601",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335046404",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040150",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644005",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040120",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811604",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189058910",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811608",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811607",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335046407",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041260",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009521",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047595",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811606",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047521",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934029115",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816603",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335046409",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041290",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009542",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051310",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788811609",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047530",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205036263",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934058030",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065101",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005930",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934058040",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051330",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205036218",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041221",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205072928",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205042142",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065107",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048501",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934083130",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041200",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205036224",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335046400",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335046401",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041205",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335206903",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335046403",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205036206",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041230",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205042128",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335046405",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335046406",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019301",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040130",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065105",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205036215",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048401",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205042140",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065108",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335065102",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335304401",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040140",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162248501",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205042120",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189058921",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205042163",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047501",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335206901",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006830",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051320",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006860",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205072942",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335046402",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162248500",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041220",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205072963",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040112",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189058915",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006820",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081821",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006840",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189058930",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041210",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335206904",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047504",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117200",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006821",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117205",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049101",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789040121",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047512",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047540",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041201",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041218",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041250",
      "ndc_label_name": "predniSONE Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527293137",
      "ndc_label_name": "predniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959057021",
      "ndc_label_name": "predniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629226001",
      "ndc_label_name": "PredniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054474225",
      "ndc_label_name": "PredniSONE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746078201",
      "ndc_label_name": "predniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135077501",
      "ndc_label_name": "predniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380083506",
      "ndc_label_name": "PredniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291076801",
      "ndc_label_name": "predniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954005710",
      "ndc_label_name": "PredniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788810803",
      "ndc_label_name": "predniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054874025",
      "ndc_label_name": "PredniSONE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356058130",
      "ndc_label_name": "predniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090145500",
      "ndc_label_name": "PredniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788885803",
      "ndc_label_name": "predniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603533621",
      "ndc_label_name": "PredniSONE TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090723500",
      "ndc_label_name": "predniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090782500",
      "ndc_label_name": "predniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407035601",
      "ndc_label_name": "predniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651048501",
      "ndc_label_name": "predniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788818403",
      "ndc_label_name": "predniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117001",
      "ndc_label_name": "predniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788885801",
      "ndc_label_name": "predniSONE Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378064201",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816710",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816715",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001829",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816720",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378064210",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001820",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816760",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999011012",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816721",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816718",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440216715",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527293437",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440216720",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001825",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527293441",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090199000",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070306",
      "ndc_label_name": "PredniSONE TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816730",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591544301",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591544305",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356081814",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378064205",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070314",
      "ndc_label_name": "PredniSONE TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090278902",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070312",
      "ndc_label_name": "PredniSONE TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603533928",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591544310",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603533921",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291077150",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603533932",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090278600",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090612307",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070315",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291077101",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904712761",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070305",
      "ndc_label_name": "PredniSONE TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070320",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135077801",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090280400",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012721",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070318",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070310",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135077805",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070325",
      "ndc_label_name": "PredniSONE TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070330",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135077810",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090280401",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012742",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070321",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198909",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063070309",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090278905",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090199100",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999011014",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090280407",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032511",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198901",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090278901",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063091121",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333005",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333007",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198902",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333000",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154494600",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090278903",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090280402",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198903",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333603",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090478401",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090198905",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333002",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760084012",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090278909",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333001",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090199001",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090478502",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090478507",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090199005",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333500",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010830",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090280405",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090612205",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090199002",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090612302",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090612201",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333601",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090478505",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032614",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090322400",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090612300",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090199007",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407092305",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090612301",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090612202",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090612209",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080721",
      "ndc_label_name": "PredniSONE TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333602",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012720",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333605",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348099810",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407035901",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012700",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090625900",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866303",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333609",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032500",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090612305",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700020330",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012715",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012725",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436432602",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881901",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090478500",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700020315",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407035905",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651048805",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012718",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032515",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012710",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009620",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090478501",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760000221",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012707",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687092501",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032510",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032518",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760071521",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934047112",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090612203",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135055330",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012712",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760000230",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348099820",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032530",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760079021",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934047115",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436175001",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561012205",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012730",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760079721",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348099830",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700020305",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032623",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954006030",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436175004",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629158704",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032512",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032620",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219170801",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700020321",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919034221",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205023906",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959012737",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017230",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032520",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032630",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760084021",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687014511",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561012202",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205023918",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032514",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775200",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700020320",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919034210",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010821",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760071512",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629158705",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205040312",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032521",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775201",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651048801",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080707",
      "ndc_label_name": "PredniSONE TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919079210",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760079712",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017220",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205040710",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700020310",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775203",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746017506",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080712",
      "ndc_label_name": "PredniSONE TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080720",
      "ndc_label_name": "PredniSONE TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032610",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775204",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074114",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760079012",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821202",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746017509",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080715",
      "ndc_label_name": "PredniSONE TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080730",
      "ndc_label_name": "PredniSONE TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032615",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775205",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079721",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919010812",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821205",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219170805",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080718",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629158708",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135055390",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821201",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335304601",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032605",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821208",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687014501",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561012201",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775209",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187040715",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821204",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189043015",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919034220",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866308",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687092511",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629158702",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866302",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080706",
      "ndc_label_name": "PredniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866304",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039306",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080705",
      "ndc_label_name": "PredniSONE TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881903",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032612",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629243501",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866305",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080710",
      "ndc_label_name": "PredniSONE TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881902",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006915",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080714",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881904",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629158703",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380078508",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009615",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380078506",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881908",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041300",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629158701",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788930902",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739058810",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017210",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934030730",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017215",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009630",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041310",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629158706",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934047110",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380078507",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775206",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074118",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009610",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934021815",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048701",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017242",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205023920",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017212",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881905",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335152501",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934067412",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934021830",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934021810",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775202",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205040310",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267086004",
      "ndc_label_name": "PredniSONE TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074121",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189043010",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205023907",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954006010",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079715",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788775208",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205040718",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866301",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335207905",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039315",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205023912",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205040307",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335207906",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821203",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079710",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934030721",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162248600",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789050912",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205040306",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039312",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162248601",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934030710",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039321",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934047121",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189043030",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006920",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205040720",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039314",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039305",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934030715",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041321",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954006020",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006910",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041301",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074110",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039320",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041330",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934047120",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048703",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205023910",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048603",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041320",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074115",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039325",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005510",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934047130",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005520",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205040305",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005515",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048702",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079730",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789050021",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335304701",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074120",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189043005",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205040721",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189043021",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335085701",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039330",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789050915",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047301",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039309",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047304",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205040730",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047321",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039310",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047395",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041318",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789050906",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047325",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041360",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079720",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010502",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047330",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010503",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041350",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048605",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789050909",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048705",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335207901",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005530",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041390",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048601",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048602",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189043020",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005521",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789044821",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006921",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006930",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010501",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048604",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048704",
      "ndc_label_name": "predniSONE Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378064010",
      "ndc_label_name": "PredniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816512",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054982825",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816521",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591505210",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054872425",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378064001",
      "ndc_label_name": "PredniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054472825",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603533721",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603533732",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816520",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816530",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008060",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096830",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440216512",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054472831",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090581403",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291076901",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816590",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527293237",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090240304",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999000842",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816510",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054982831",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090661901",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081960",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527293243",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291072710",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407035710",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090240204",
      "ndc_label_name": "PredniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440816560",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999000805",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090661904",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090240207",
      "ndc_label_name": "PredniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591505201",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090327300",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022010",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090327304",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135077601",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090240201",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090750500",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090336106",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096855",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090327303",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002035220",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090327307",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135077610",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090331006",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090768407",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090581401",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090335401",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090335400",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348050521",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090331004",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063096821",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090581400",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090768606",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090581407",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090335404",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090335403",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651048699",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090712400",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090240200",
      "ndc_label_name": "PredniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090661907",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022030",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090581606",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090335407",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090768400",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219170607",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436432403",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090240203",
      "ndc_label_name": "PredniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022040",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002035200",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090661900",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090662106",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090768800",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760079621",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022000",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090240306",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002035230",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348050515",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090768403",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090662300",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002035210",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017342",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022020",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090336104",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348050510",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700020948",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746017206",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090768401",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002035215",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788737203",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022075",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090581404",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651048601",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032142",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219170601",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090768404",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700020905",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788737208",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687012201",
      "ndc_label_name": "PredniSONE TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090661903",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135047118",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099710",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760093221",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407035701",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760025521",
      "ndc_label_name": "PredniSONE TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788769201",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687012211",
      "ndc_label_name": "PredniSONE TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436172005",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002015",
      "ndc_label_name": "PredniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629160500",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099730",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022060",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919032121",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788826703",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687090301",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436432401",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099721",
      "ndc_label_name": "PredniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629160505",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187099760",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002035221",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037321",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857908",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919037330",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407092110",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629160502",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629226301",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561012002",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561012001",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135047190",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934010121",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002010",
      "ndc_label_name": "PredniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022021",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788769204",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629226401",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63561012005",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629160507",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002021",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934069921",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629226101",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022036",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335085607",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017321",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629160506",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629160508",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187002036",
      "ndc_label_name": "PredniSONE TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205053721",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788737204",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700020921",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610064160",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335085609",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954005820",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380078308",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380078306",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335085603",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788737209",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700020930",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083453",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335213401",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335085602",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017330",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017320",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335085608",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335085604",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746017210",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162248400",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335213404",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335304301",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017340",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544039960",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117100",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072160",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687090311",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189059321",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335304201",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162214900",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788737201",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788826702",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789041330",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083430",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036521",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047421",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023530",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162248401",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954005810",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335122004",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804022310",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049830",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629160503",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425006901",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425006801",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189027521",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335085601",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006730",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048201",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047901",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629160504",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048101",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117101",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006721",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629226201",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023507",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017360",
      "ndc_label_name": "PredniSONE TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789041321",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788737202",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047404",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788769202",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006748",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788769203",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010601",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788769208",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788769209",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788857903",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934029021",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335085605",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083460",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083480",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789023521",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047401",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789047495",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048001",
      "ndc_label_name": "predniSONE Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090566000",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135077901",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289033007",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090010200",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407036001",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001925",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527293537",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054001920",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348050905",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090744100",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687085401",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189048907",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959095405",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090622500",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090637600",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919099507",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651048901",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959095400",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789042605",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380094906",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289033005",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205046007",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205066505",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954006110",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187024307",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687085411",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205075505",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041421",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289033010",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187024305",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335971502",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041405",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788889805",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041418",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041420",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746078301",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934013705",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189024607",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205046005",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041410",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205046008",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041430",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041401",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041460",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420041490",
      "ndc_label_name": "predniSONE Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603533815",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 10 MG (21) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591544221",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 10 MG (21) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090100100",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 10 MG (21) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954005930",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 10 MG (21) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189064621",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 10 MG (21) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591544243",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 10 MG (48) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603533831",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 10 MG (48) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954005940",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 10 MG (48) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603533715",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 5 MG (21) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591505221",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 5 MG (21) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629462401",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 5 MG (21) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090043900",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 5 MG (21) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788728102",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 5 MG (21) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954005830",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 5 MG (21) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954005840",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 5 MG (48) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591505243",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 5 MG (48) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603533731",
      "ndc_label_name": "predniSONE Tablet Therapy Pack 5 MG (48) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090650300",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904700161",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228064805",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808023701",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061305",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752306",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668036105",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228285909",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228064890",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029479",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407051290",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061390",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029490",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752309",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029466",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547050909",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268050011",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077360",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077390",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268050001",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081730",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835906",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335068988",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077330",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059160",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081790",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081760",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050611",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762134801",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836006",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228035390",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505379609",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980041309",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760068130",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836009",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046590",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050601",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238131309",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407057790",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332012290",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980041310",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760075360",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205032390",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752301",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836001",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367042709",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135044690",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046505",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862076190",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835909",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087290",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835901",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836003",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518364300",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752303",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205032360",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788835903",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367042705",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335178901",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367032709",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097095705",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087272",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087200",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087255",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097068105",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205032330",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335178902",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205063930",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031646",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335174002",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031670",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087260",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518364301",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087211",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031654",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205063960",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031692",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335178903",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087153",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087267",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205033830",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610032930",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093630",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205063990",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610032946",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031680",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089430",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031653",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031630",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610032953",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162202509",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087230",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035730",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080830",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002390",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031675",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031660",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080853",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012030",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087278",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035753",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606000701",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009860",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080854",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035770",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080860",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012303",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335174001",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087130",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009830",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009890",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089460",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093646",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080875",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017003",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610032970",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087146",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420058390",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027702",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003390",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024860",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610087192",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619012501",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080870",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089453",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610089446",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002360",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420058330",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003330",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093653",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205001490",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080880",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603035501",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002330",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282057190",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016603",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027701",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420058360",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093692",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027703",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162154409",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003360",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012060",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012090",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024830",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024890",
      "ndc_label_name": "Pregabalin Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904700261",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808023801",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029566",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228286009",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061405",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335069088",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228035490",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061490",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029590",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332012390",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700089190",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668036205",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029579",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407057890",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760050760",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547051009",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752401",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862076290",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687051701",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228064990",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700089130",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760068230",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097068205",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228064905",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834709",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752409",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687051711",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629819802",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700089160",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980041410",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367042809",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268050101",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846001",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834701",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760050790",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980041409",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762135101",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097095805",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205060830",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268050111",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866703",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834706",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135044790",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046605",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046690",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367042805",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087355",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407051390",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866706",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846009",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629819803",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752403",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205060890",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031753",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087360",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505379709",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367032809",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866701",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752406",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846003",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205069490",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031754",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179201",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205039690",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087300",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205039630",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834703",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866709",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335174503",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061854",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179202",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087330",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087311",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205039660",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846006",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205069460",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031746",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061870",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035230",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087367",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087378",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087372",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238131409",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031730",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084553",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162154509",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035253",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087390",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035246",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033430",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205060860",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031770",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162154506",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002090",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061853",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335174501",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071946",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033446",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335174502",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084530",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003430",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009990",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834030090",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179203",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071953",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035270",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033453",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084570",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003490",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039701",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282057290",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084546",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162230400",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061830",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033470",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162202609",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606000801",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061846",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420065860",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084554",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162230409",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009930",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071930",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018501",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012130",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012160",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017802",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024990",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002060",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012190",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071970",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619012601",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024960",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017803",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039703",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804018860",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003460",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002030",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012403",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205001590",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603035601",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009960",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017801",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024930",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420065830",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018503",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039702",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420065890",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018502",
      "ndc_label_name": "Pregabalin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407057990",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668036305",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808023901",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228286109",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029690",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407051490",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335069188",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061505",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332012490",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547051109",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862076390",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904700304",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090650400",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980041509",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072960",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061590",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087400",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760048690",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752706",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228065005",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228035590",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046705",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752703",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228065090",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087411",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097095905",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031853",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762135401",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046790",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335182202",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367042909",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700096460",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087472",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238131509",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087467",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367032909",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752701",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335969103",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335182201",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505379809",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075430",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087430",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075930",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367042905",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097068305",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075946",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092630",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752709",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075453",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087478",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092646",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087460",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335182203",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075960",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094853",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087455",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094860",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087490",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003590",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031830",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075446",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094830",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603035701",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075953",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189024130",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092653",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282057390",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031846",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092680",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189024190",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030803",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075980",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420065930",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092660",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205001690",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033053",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420065960",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010030",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012290",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012230",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162154609",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036153",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010090",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003560",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162202709",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189024160",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420065990",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012260",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003530",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030802",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010060",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619012701",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030801",
      "ndc_label_name": "Pregabalin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808024001",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335069288",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668036405",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762136001",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904700404",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547051209",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228065105",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228286209",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228035690",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228065190",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061605",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367043009",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862076490",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029790",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505379909",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046890",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980041609",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407051690",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061690",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079146",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046805",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407058090",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332012590",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087555",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087511",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518298000",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097096105",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094760",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518364200",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097068405",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238131609",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087578",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035853",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087530",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087500",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189032860",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087560",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367033009",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094646",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010190",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094630",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076053",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031953",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012330",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087567",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087572",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619012801",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079153",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004590",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087590",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076046",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094692",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094654",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031946",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094653",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162202809",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282057490",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033153",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094753",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010160",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162154709",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610094730",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039901",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012390",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012360",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010130",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039903",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420066060",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004530",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420066030",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420066090",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039902",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004560",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205001790",
      "ndc_label_name": "Pregabalin Capsule 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029190",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752001",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228285609",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505379309",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335068688",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904699104",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668035805",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904699161",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268049711",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086930",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061005",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752009",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228035090",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228064505",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980041009",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547050609",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407057490",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086955",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061090",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205073360",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228064590",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762134201",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238131009",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090755800",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700082790",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031353",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268049701",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086900",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687047311",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687047301",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367042409",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046205",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367032409",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031370",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407050990",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804004960",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332011990",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862075890",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086967",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086911",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086978",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009530",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752003",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033530",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046290",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752006",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086972",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009590",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179103",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097067705",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097095405",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030701",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086960",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086990",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033553",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030702",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036553",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031330",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367042405",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043302",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079253",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093153",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179102",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043303",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093130",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282056890",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610036530",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619012201",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093146",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420011760",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079230",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420011790",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093154",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420066260",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162202209",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603035201",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205001190",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093160",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009560",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162154104",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420011730",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189011590",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030703",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026990",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043301",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420066230",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420066290",
      "ndc_label_name": "Pregabalin Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407051590",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228286309",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808024101",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407058190",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547051309",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090490",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668036505",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904700504",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788765606",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061705",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061790",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332012690",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762136401",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097096205",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335069388",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228035790",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788765609",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029890",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228065205",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862076590",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788765603",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367033109",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228065290",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505380009",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087630",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090460",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046905",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788765601",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087600",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367043105",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087672",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760050960",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088746",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980041709",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046990",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610032830",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610032853",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092560",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035130",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629824801",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092530",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087660",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097068505",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082346",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088753",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282057590",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080046",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238131709",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092553",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087690",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087611",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082353",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010290",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420066130",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082330",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367043109",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162211509",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035153",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087655",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092580",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012460",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017701",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082360",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610032030",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012430",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080030",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087667",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189025160",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425012903",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080053",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088730",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610032053",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016003",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088760",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087678",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205001890",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092546",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420066190",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610032046",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162154809",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603035801",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017703",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082380",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010230",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420066160",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619012901",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420010260",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012490",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425017702",
      "ndc_label_name": "Pregabalin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061105",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407051090",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228285709",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228064690",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904699261",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668035905",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335068788",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061190",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547050709",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077490",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029266",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436032502",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808023501",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029279",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228035190",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029290",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077460",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135044490",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228064605",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367032509",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700080430",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436032503",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268049801",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407057590",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076860",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629819502",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700080460",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367042505",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700080490",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077430",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268049811",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687048401",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518306001",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980041109",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505379409",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518257100",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760075060",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762134401",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436032501",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687048411",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087000",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980041110",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760075030",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087030",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629819503",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046390",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760020530",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760020560",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087078",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862075990",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046305",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087067",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097095505",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838303",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760020590",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752106",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335175103",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838301",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752109",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335130001",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087011",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838306",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332012090",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847201",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031430",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367042509",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838309",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088246",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087055",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847203",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629819501",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518306000",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031475",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518363600",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097067805",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093060",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087060",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847206",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752101",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205069660",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082046",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335201502",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238131109",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002830",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087072",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788847209",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752103",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179002",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088253",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082053",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205055660",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002502",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335130003",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205055630",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335201503",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093053",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093054",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093030",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087090",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002601",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179003",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031453",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035030",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002860",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162202309",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610093046",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179001",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032703",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031470",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031466",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035053",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009630",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189001990",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189001930",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031446",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024760",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033253",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031480",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061953",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002503",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282056990",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420065660",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603035301",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042101",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205001290",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033230",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082030",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804018430",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009690",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162154209",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420065630",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189001960",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024790",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189001982",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610082060",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420011830",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420011860",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420011890",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619012301",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015201",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420065690",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002890",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420024730",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606000501",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002501",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009660",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042102",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002603",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032701",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002701",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042103",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015202",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015203",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032702",
      "ndc_label_name": "Pregabalin Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029366",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228285809",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061205",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029379",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700080530",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722061290",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904700061",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090503801",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598029390",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668036005",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090507100",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090503800",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760048560",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335068888",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808023601",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090593800",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090446500",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268049911",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090647700",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090679300",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046405",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090679301",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547050809",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077530",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228064790",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436032601",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268049901",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228064705",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839103",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407051190",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228035290",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762134601",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505379509",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077590",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436032602",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049501",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097067905",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407057690",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760075130",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760048590",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087190",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700080560",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436032603",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332012190",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367042609",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700077560",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839101",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135044590",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335147603",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700080590",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049511",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980041209",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518359700",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760048530",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839106",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877046490",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335178803",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862076090",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518359701",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752201",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029860",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760075160",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205062160",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839109",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072930",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238131209",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518359702",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752203",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081660",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980041210",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205062190",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518294800",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072953",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367042605",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205030430",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067760",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087130",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752206",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087160",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067790",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072970",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335175803",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067730",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087155",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087167",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752209",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335147602",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087100",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076546",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033370",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335147601",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031530",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335175801",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097095605",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031570",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087111",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076570",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075830",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335175802",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031553",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033330",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367032609",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067730",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087172",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079970",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075860",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335178801",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033346",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079930",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518294801",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075846",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335178802",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003260",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076530",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610031546",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067753",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079954",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205030460",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076553",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035630",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420011990",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076580",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033353",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075546",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162202409",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205030490",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079946",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035653",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002802",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002190",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035670",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162154302",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420065760",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205087178",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72606000601",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075530",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002803",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003290",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002160",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014702",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425011601",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075553",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420065790",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079992",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002902",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009790",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009760",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420009730",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002903",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610075853",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002801",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420022130",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014703",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420011930",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420011960",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002901",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041702",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076575",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003002",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619012401",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041701",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420065730",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804017060",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079953",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425003001",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189002130",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041703",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003230",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804017090",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205001390",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603035401",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282057090",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420022160",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420022190",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041704",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804020760",
      "ndc_label_name": "Pregabalin Capsule 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43292055515",
      "ndc_label_name": "Prenatal (w/Iron & FA) Tablet 27-0.8 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292055670",
      "ndc_label_name": "Prenatal (w/Iron & FA) Tablet 27-0.8 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55520000181",
      "ndc_label_name": "Prenatal + Complete Multi Therapy Pack 0.267 & 373 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58487002831",
      "ndc_label_name": "Prenatal Formula A-Free TABLET 9-0.267 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54629899260",
      "ndc_label_name": "Prenatal Formula CAPSULE 28-0.8-235 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58177021204",
      "ndc_label_name": "Prenatal MR 90 Fe Tablet Extended Release 90-1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31604002749",
      "ndc_label_name": "Prenatal Multi +DHA CAPSULE 27-0.8-228 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "31604002766",
      "ndc_label_name": "Prenatal Multi +DHA CAPSULE 27-0.8-228 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917015670",
      "ndc_label_name": "Prenatal Multi +DHA CAPSULE 27-0.8-250 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40985027175",
      "ndc_label_name": "Prenatal Multivitamin + DHA 28-0.8 & 200 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "42291068601",
      "ndc_label_name": "Prenatal Plus Tablet 27-1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162066810",
      "ndc_label_name": "Prenatal Plus Tablet 27-1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904531346",
      "ndc_label_name": "Prenatal TABLET 27-0.8 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090344600",
      "ndc_label_name": "Prenatal Tablet 27-0.8 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904531360",
      "ndc_label_name": "Prenatal TABLET 27-0.8 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "35356036630",
      "ndc_label_name": "Prenatal Tablet 27-0.8 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356036690",
      "ndc_label_name": "Prenatal Tablet 27-0.8 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77333071510",
      "ndc_label_name": "Prenatal TABLET 27-0.8 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "77333071525",
      "ndc_label_name": "Prenatal TABLET 27-0.8 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58487003503",
      "ndc_label_name": "Prenatal TABLET 6.75-0.2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58487003501",
      "ndc_label_name": "Prenatal TABLET 6.75-0.2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58487003502",
      "ndc_label_name": "Prenatal TABLET 6.75-0.2 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54738005001",
      "ndc_label_name": "Prenatal Vitamin and Mineral TABLET 28-0.8 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917009311",
      "ndc_label_name": "Prenatal+DHA 28-0.975 & 200 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917019108",
      "ndc_label_name": "Prenatal+DHA 28-0.975 & 200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30768030293",
      "ndc_label_name": "Prenatal/Omega-3/FA/Iron Capsule 28-0.8-530 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00005200002",
      "ndc_label_name": "Prevnar 20 Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090172300",
      "ndc_label_name": "Prezcobix Tablet 800-150 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59676057530",
      "ndc_label_name": "Prezcobix TABLET 800-150 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54569640300",
      "ndc_label_name": "Prezista Suspension 100 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59676056501",
      "ndc_label_name": "Prezista Suspension 100 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59676056401",
      "ndc_label_name": "Prezista Tablet 150 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356028460",
      "ndc_label_name": "Prezista Tablet 600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54569608600",
      "ndc_label_name": "Prezista Tablet 600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59676056201",
      "ndc_label_name": "Prezista Tablet 600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59676056301",
      "ndc_label_name": "Prezista Tablet 75 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59676056630",
      "ndc_label_name": "Prezista Tablet 800 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090132700",
      "ndc_label_name": "Prezista Tablet 800 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54569636600",
      "ndc_label_name": "Prezista Tablet 800 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00088210201",
      "ndc_label_name": "Priftin Tablet 150 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00088210224",
      "ndc_label_name": "Priftin TABLET 150 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440818860",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440818890",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440818830",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80005011811",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052201",
      "ndc_label_name": "Primidone TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584068550",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268068715",
      "ndc_label_name": "Primidone TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052210",
      "ndc_label_name": "Primidone TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135052205",
      "ndc_label_name": "Primidone TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407063801",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527123101",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090163600",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291051101",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603061001",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017730",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268068711",
      "ndc_label_name": "Primidone TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291051150",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746054501",
      "ndc_label_name": "Primidone TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527123110",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584068510",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591532101",
      "ndc_label_name": "Primidone TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017701",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090408300",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888004601",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084020301",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888004605",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084020311",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017782",
      "ndc_label_name": "Primidone Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135054005",
      "ndc_label_name": "Primidone TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268068615",
      "ndc_label_name": "Primidone TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527130101",
      "ndc_label_name": "Primidone TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268068611",
      "ndc_label_name": "Primidone TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000594",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527130105",
      "ndc_label_name": "Primidone TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007992",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407063701",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291050901",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746054405",
      "ndc_label_name": "Primidone TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135054001",
      "ndc_label_name": "Primidone TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584068450",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007960",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407063705",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007998",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084020201",
      "ndc_label_name": "Primidone TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291050950",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135046890",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019160",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000580",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019180",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084020211",
      "ndc_label_name": "Primidone TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019109",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019198",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999055900",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007980",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054094",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000592",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054080",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000560",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019192",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054009",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746054401",
      "ndc_label_name": "Primidone TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007994",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076392",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019194",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059080",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076360",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059092",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076394",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584068410",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059060",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80005011711",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054060",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059094",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888004501",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189021660",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603060902",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000598",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017830",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80005011714",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054092",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076380",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095272",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017801",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789017882",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603060901",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095211",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095290",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095200",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095260",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095230",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095255",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888004505",
      "ndc_label_name": "Primidone Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008002008",
      "ndc_label_name": "Probenecid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527136710",
      "ndc_label_name": "Probenecid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591534701",
      "ndc_label_name": "Probenecid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353083960",
      "ndc_label_name": "Probenecid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289071502",
      "ndc_label_name": "Probenecid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527136701",
      "ndc_label_name": "Probenecid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591534710",
      "ndc_label_name": "Probenecid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571083101",
      "ndc_label_name": "Probenecid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135054101",
      "ndc_label_name": "Probenecid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353076508",
      "ndc_label_name": "Probenecid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135054110",
      "ndc_label_name": "Probenecid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289071517",
      "ndc_label_name": "Probenecid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162223701",
      "ndc_label_name": "Probenecid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571083110",
      "ndc_label_name": "Probenecid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162238601",
      "ndc_label_name": "Probenecid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289071515",
      "ndc_label_name": "Probenecid TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099108",
      "ndc_label_name": "Probenecid Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641613501",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789070002",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641613525",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155052331",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789070007",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713035125",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121158005",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713035109",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155052341",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155029442",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155029431",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021079003",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066009001",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155049731",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155049742",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155029441",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090454800",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150036025",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145011910",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145011901",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457064002",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "25021079002",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069037125",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43066009025",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572058001",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67457064099",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634077802",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069037101",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70121158007",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55150036001",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266020410",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860077802",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70860077841",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572058025",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266020401",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83634077841",
      "ndc_label_name": "Prochlorperazine Edisylate Solution 10 MG/2ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268068511",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378511001",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135036801",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440819106",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904738206",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291072901",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063074206",
      "ndc_label_name": "Prochlorperazine Maleate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356056460",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047660",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241028701",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356032500",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090185400",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090283900",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063074215",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047610",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348011415",
      "ndc_label_name": "Prochlorperazine Maleate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762802",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047615",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047624",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047602",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289022415",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268068515",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047620",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289022404",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870802",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651077401",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687082565",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687082511",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135067490",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289022412",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959047630",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762801",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870803",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219203901",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762805",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603016901",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462094701",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289022420",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746011506",
      "ndc_label_name": "Prochlorperazine Maleate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762806",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189050330",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462089001",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870805",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870801",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710166801",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762803",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954068910",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870806",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315026601",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051890",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452031020",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051815",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452047220",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162226201",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051801",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090010805",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440819012",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268068415",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440819006",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241028601",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440219012",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378510501",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291072801",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090011100",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090011005",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187087730",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063035306",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090010900",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904738106",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267027112",
      "ndc_label_name": "Prochlorperazine Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090763405",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629184101",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348011630",
      "ndc_label_name": "Prochlorperazine Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452047120",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746011306",
      "ndc_label_name": "Prochlorperazine Maleate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090714705",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090224105",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710166701",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135067390",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629184102",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629184103",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219203801",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090224200",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462088901",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629184104",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452030920",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268068411",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954068810",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051790",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603016801",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651077301",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687081411",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687081465",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315026501",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789051701",
      "ndc_label_name": "Prochlorperazine Maleate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65649051112",
      "ndc_label_name": "Proctocort Suppository 30 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603813611",
      "ndc_label_name": "Proctosert HC SUPPOSITORY 30 MG",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10631040701",
      "ndc_label_name": "Proctosol HC Cream 2.5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162216502",
      "ndc_label_name": "Proctosol HC Cream 2.5 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714015701",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090592801",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291078401",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054082925",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090465601",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598034901",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478076610",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090677100",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651015201",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090647500",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090683500",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291078430",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090592800",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090252700",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090252701",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162080710",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335973901",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090683501",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429086801",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73190006401",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090647501",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090324000",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090465600",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406803",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189020490",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870903",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788829603",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452023320",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090677101",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090211",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543037410",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090230",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407098001",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090260",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090272",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090255",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700016201",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090290",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189065490",
      "ndc_label_name": "Progesterone Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788829503",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598035001",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291078530",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478076710",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162080810",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714015801",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054083025",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090355",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090372",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407098101",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429086901",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291078501",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205066930",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629853001",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651015301",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788401503",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871903",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452023420",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090390",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70700016301",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205029330",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543037510",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73190006501",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090330",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189021790",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090311",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205090360",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034790",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335224201",
      "ndc_label_name": "Progesterone Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "38779004304",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552073807",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779004301",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779004309",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779004305",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779004303",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452606102",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779230909",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779230907",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552082907",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779004306",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779230904",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452606004",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779004308",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452606104",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779324709",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779324708",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927512400",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779004307",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452606001",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452606005",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779230908",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552082904",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452606101",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552073806",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592060701",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779230902",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452606003",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452606105",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452606006",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552127909",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50488101201",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552127905",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991112404",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779230905",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452606103",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592060705",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552073803",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927353000",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552073805",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552127906",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052007905",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452606002",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452606106",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991112401",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927104600",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991218403",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552082903",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592060710",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052007910",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50488101200",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552082905",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991112408",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592060711",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457990403",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552082906",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991218401",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052007920",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552073804",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991112402",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991218405",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60592060725",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71052007901",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552127902",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457990401",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393010110",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552127903",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991112403",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981000501",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991112407",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393010113",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552127907",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457990404",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981000504",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552127904",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991112405",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981000502",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092997404",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981000505",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991218402",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457990407",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092997405",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457990406",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991218404",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092997402",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457990402",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092997401",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68981000503",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092997408",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70457990405",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092997406",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393010108",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092997403",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393010111",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092997407",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393010112",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71092997409",
      "ndc_label_name": "Progesterone Micronized POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82393010107",
      "ndc_label_name": "Progesterone Micronized Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533070501",
      "ndc_label_name": "Prolastin-C SOLUTION 1000 MG/20ML Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13533070511",
      "ndc_label_name": "Prolastin-C SOLUTION 1000 MG/20ML Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513071001",
      "ndc_label_name": "Prolia Solution Prefilled Syringe 60 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55513071021",
      "ndc_label_name": "Prolia Solution Prefilled Syringe 60 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641092825",
      "ndc_label_name": "Promethazine HCl SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641095525",
      "ndc_label_name": "Promethazine HCl SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39822552503",
      "ndc_label_name": "Promethazine HCl SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641094831",
      "ndc_label_name": "Promethazine HCl SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641149535",
      "ndc_label_name": "Promethazine HCl SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641094835",
      "ndc_label_name": "Promethazine HCl SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641092821",
      "ndc_label_name": "Promethazine HCl SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641095521",
      "ndc_label_name": "Promethazine HCl SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641620801",
      "ndc_label_name": "Promethazine HCl SOLUTION 25 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641149531",
      "ndc_label_name": "Promethazine HCl SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641620825",
      "ndc_label_name": "Promethazine HCl SOLUTION 25 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39822552502",
      "ndc_label_name": "Promethazine HCl SOLUTION 25 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39822555005",
      "ndc_label_name": "Promethazine HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090087900",
      "ndc_label_name": "Promethazine HCl Solution 50 MG/ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "39822555006",
      "ndc_label_name": "Promethazine HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641149635",
      "ndc_label_name": "Promethazine HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641094935",
      "ndc_label_name": "Promethazine HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641092925",
      "ndc_label_name": "Promethazine HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641092921",
      "ndc_label_name": "Promethazine HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641094931",
      "ndc_label_name": "Promethazine HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641095625",
      "ndc_label_name": "Promethazine HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641095621",
      "ndc_label_name": "Promethazine HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00641149631",
      "ndc_label_name": "Promethazine HCl SOLUTION 50 MG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121185416",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121092716",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999026204",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856060805",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808005102",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383080116",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00116402316",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33261060601",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432060816",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033050034",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118991401",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679060816",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090643100",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080408",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118003401",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135077447",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70408014634",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959080404",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135077405",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752013812",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162067890",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135077424",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135077441",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162207102",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033001650",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033001605",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629915101",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162237702",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788702801",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788816204",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162195802",
      "ndc_label_name": "Promethazine HCl Solution 6.25 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629844601",
      "ndc_label_name": "Promethazine HCl Suppository 12.5 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959073112",
      "ndc_label_name": "Promethazine HCl Suppository 12.5 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802075830",
      "ndc_label_name": "Promethazine HCl SUPPOSITORY 12.5 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722004032",
      "ndc_label_name": "Promethazine HCl Suppository 12.5 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722004031",
      "ndc_label_name": "Promethazine HCl Suppository 12.5 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672529601",
      "ndc_label_name": "Promethazine HCl SUPPOSITORY 12.5 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802075800",
      "ndc_label_name": "Promethazine HCl SUPPOSITORY 12.5 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722004131",
      "ndc_label_name": "Promethazine HCl Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802075900",
      "ndc_label_name": "Promethazine HCl SUPPOSITORY 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999034012",
      "ndc_label_name": "Promethazine HCl Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722004132",
      "ndc_label_name": "Promethazine HCl Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063006002",
      "ndc_label_name": "Promethazine HCl SUPPOSITORY 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063006006",
      "ndc_label_name": "Promethazine HCl SUPPOSITORY 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672529701",
      "ndc_label_name": "Promethazine HCl SUPPOSITORY 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063006004",
      "ndc_label_name": "Promethazine HCl SUPPOSITORY 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289092804",
      "ndc_label_name": "Promethazine HCl SUPPOSITORY 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959023712",
      "ndc_label_name": "Promethazine HCl Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802075930",
      "ndc_label_name": "Promethazine HCl SUPPOSITORY 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289092806",
      "ndc_label_name": "Promethazine HCl SUPPOSITORY 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090274701",
      "ndc_label_name": "Promethazine HCl Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289092802",
      "ndc_label_name": "Promethazine HCl SUPPOSITORY 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090274702",
      "ndc_label_name": "Promethazine HCl Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289092879",
      "ndc_label_name": "Promethazine HCl SUPPOSITORY 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629844501",
      "ndc_label_name": "Promethazine HCl Suppository 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959091430",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084015411",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087501",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000201",
      "ndc_label_name": "Promethazine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687066011",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746074501",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335098900",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999090220",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004740",
      "ndc_label_name": "Promethazine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289094802",
      "ndc_label_name": "Promethazine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687066001",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090621601",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001016100",
      "ndc_label_name": "Promethazine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429014901",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335098909",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004730",
      "ndc_label_name": "Promethazine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004710",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084015401",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040212",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071044860",
      "ndc_label_name": "Promethazine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919004712",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382004001",
      "ndc_label_name": "Promethazine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162074510",
      "ndc_label_name": "Promethazine HCl TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040230",
      "ndc_label_name": "Promethazine HCl Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135049501",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440819506",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440819510",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904730461",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904646161",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440819504",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591530710",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087410",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634041871",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591530701",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440819512",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000310",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356067115",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781183001",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135049510",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087420",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040560",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781183010",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440819520",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040505",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040502",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000301",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356067112",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087479",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087430",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040520",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040579",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040510",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040504",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000350",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087406",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090029000",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090029005",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040530",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999059430",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040515",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040525",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063040512",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087415",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090029001",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190201",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087401",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999059490",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087402",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190400",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090445301",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087495",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090029006",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090445200",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087412",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090029200",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087404",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090445305",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090445306",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053402",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190205",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090460800",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087425",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090307700",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087405",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090481300",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090481309",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053415",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090290600",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090475000",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090029009",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090445309",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190206",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436052102",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053410",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002040230",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090481301",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090481100",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190200",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053412",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190209",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053401",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053420",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429015010",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053490",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090481305",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090481306",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053428",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090190300",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053445",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002040220",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000810",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002040210",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090487500",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436052101",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700022160",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090445300",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002040205",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348011712",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919019130",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700022120",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700022130",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053460",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000860",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053430",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746052101",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000812",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919019160",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082915",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934024310",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746052110",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001016200",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760045620",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118530709",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629174206",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063010",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629174205",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012620",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118530705",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382004105",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919019112",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760083020",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162052110",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063012",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162052111",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065830",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429015001",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382004110",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187003830",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000815",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017710",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063030",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267017790",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001202",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919000830",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012630",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187094930",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919019110",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001016208",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187003810",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065810",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001209",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001016203",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065812",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629174208",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063060",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382004101",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082912",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001200",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335113906",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934035312",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001201",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084015501",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082910",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934024330",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187094910",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001203",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082920",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001205",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001207",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788601",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187082930",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065820",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788602",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001206",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267081306",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001208",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335135907",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934024312",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084015511",
      "ndc_label_name": "Promethazine HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017630",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934024320",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012615",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788603",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335113902",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012612",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205080515",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788608",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205080530",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017612",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335001204",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012610",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017620",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189017610",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425026501",
      "ndc_label_name": "Promethazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001016300",
      "ndc_label_name": "Promethazine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746052201",
      "ndc_label_name": "Promethazine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702000401",
      "ndc_label_name": "Promethazine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591531901",
      "ndc_label_name": "Promethazine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781183201",
      "ndc_label_name": "Promethazine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063044704",
      "ndc_label_name": "Promethazine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135049601",
      "ndc_label_name": "Promethazine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429015101",
      "ndc_label_name": "Promethazine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087601",
      "ndc_label_name": "Promethazine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162052210",
      "ndc_label_name": "Promethazine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087604",
      "ndc_label_name": "Promethazine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382004201",
      "ndc_label_name": "Promethazine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959056804",
      "ndc_label_name": "Promethazine VC Syrup 6.25-5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999065704",
      "ndc_label_name": "Promethazine VC Syrup 6.25-5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121092616",
      "ndc_label_name": "Promethazine VC Syrup 6.25-5 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121092516",
      "ndc_label_name": "Promethazine VC/Codeine Syrup 6.25-5-10 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959022904",
      "ndc_label_name": "Promethazine VC/Codeine Syrup 6.25-5-10 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162204202",
      "ndc_label_name": "Promethazine-Codeine Syrup 6.25-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002032792",
      "ndc_label_name": "Promethazine-Codeine SYRUP 6.25-10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959011805",
      "ndc_label_name": "Promethazine-Codeine Syrup 6.25-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121092816",
      "ndc_label_name": "Promethazine-Codeine Syrup 6.25-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713082375",
      "ndc_label_name": "Promethazine-Codeine Syrup 6.25-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189048616",
      "ndc_label_name": "Promethazine-Codeine Syrup 6.25-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959011808",
      "ndc_label_name": "Promethazine-Codeine Syrup 6.25-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383080416",
      "ndc_label_name": "Promethazine-Codeine Syrup 6.25-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856080405",
      "ndc_label_name": "Promethazine-Codeine SYRUP 6.25-10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959011803",
      "ndc_label_name": "Promethazine-Codeine Syrup 6.25-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959011804",
      "ndc_label_name": "Promethazine-Codeine Syrup 6.25-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187027216",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090022500",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999031404",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856060405",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675501",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00116402416",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121107016",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713078075",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162068086",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675500",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090646700",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808005701",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436015541",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856158601",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090646701",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090658500",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205065404",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070008",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162203902",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070006",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090765800",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187035516",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162068090",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679060416",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959070004",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788810001",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432060416",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559075816",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70436015542",
      "ndc_label_name": "Promethazine-DM Syrup 6.25-15 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83490085007",
      "ndc_label_name": "Proneb Ultra Filter Set",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00603544825",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603544821",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591058201",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651025601",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489055101",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687070901",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687070911",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407001501",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687093001",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380026902",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559023001",
      "ndc_label_name": "Propafenone HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687053701",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687053711",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016502",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629210501",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162175101",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687093011",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629226501",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380026901",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016501",
      "ndc_label_name": "Propafenone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090113400",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603544921",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603544925",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559023101",
      "ndc_label_name": "Propafenone HCl TABLET 225 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090422700",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016402",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407001601",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591058301",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090294900",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629198801",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489055201",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629226701",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090297500",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380026802",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629226601",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162175201",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651025701",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380026801",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016401",
      "ndc_label_name": "Propafenone HCl Tablet 225 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380016301",
      "ndc_label_name": "Propafenone HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603545021",
      "ndc_label_name": "Propafenone HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407001701",
      "ndc_label_name": "Propafenone HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651025801",
      "ndc_label_name": "Propafenone HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629198901",
      "ndc_label_name": "Propafenone HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559023201",
      "ndc_label_name": "Propafenone HCl TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629928001",
      "ndc_label_name": "Propafenone HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489055301",
      "ndc_label_name": "Propafenone HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162175301",
      "ndc_label_name": "Propafenone HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380024601",
      "ndc_label_name": "Propafenone HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629226801",
      "ndc_label_name": "Propafenone HCl Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17478026312",
      "ndc_label_name": "Proparacaine HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999044215",
      "ndc_label_name": "Proparacaine HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208073006",
      "ndc_label_name": "Proparacaine HCl SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314001601",
      "ndc_label_name": "Proparacaine HCl SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959070530",
      "ndc_label_name": "Proparacaine HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090025900",
      "ndc_label_name": "Proparacaine HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00404719901",
      "ndc_label_name": "Proparacaine HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090193100",
      "ndc_label_name": "Proparacaine HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090192300",
      "ndc_label_name": "Proparacaine HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756019335",
      "ndc_label_name": "Proparacaine HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069060101",
      "ndc_label_name": "Proparacaine HCl Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527411837",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991081901",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291052401",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291052410",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991081905",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228278011",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959054330",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429012805",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162160401",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629928201",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559053201",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629206901",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205076130",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527411937",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291052510",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291052501",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991082005",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991082001",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228278111",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162160501",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429012905",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559053301",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629207001",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021501",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991081705",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804007230",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291052210",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228277811",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048830",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429012605",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021511",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919079430",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629196801",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335073101",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335023401",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527411637",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629207101",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291052201",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162160201",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991081701",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700094030",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760086730",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559053001",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788685503",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205076030",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429012705",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090726300",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228277911",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527411737",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291052310",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090042000",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687022611",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291052301",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760057630",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991081805",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760058930",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090150100",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629207201",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760053830",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687022601",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991081801",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919048930",
      "ndc_label_name": "Propranolol HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559053101",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189001830",
      "ndc_label_name": "Propranolol HCl ER Capsule Extended Release 24 Hour 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121090805",
      "ndc_label_name": "Propranolol HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121090840",
      "ndc_label_name": "Propranolol HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054372763",
      "ndc_label_name": "Propranolol HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856372801",
      "ndc_label_name": "Propranolol HCl Solution 20 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054373063",
      "ndc_label_name": "Propranolol HCl SOLUTION 40 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603548232",
      "ndc_label_name": "Propranolol HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378018210",
      "ndc_label_name": "Propranolol HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591555401",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440823092",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115165903",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904655061",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440823091",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115165901",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066215",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440823060",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090268800",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090275600",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378018201",
      "ndc_label_name": "Propranolol HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904746761",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591555410",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014601",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187083903",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440823094",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090709705",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759305",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440823090",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066211",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014701",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090709700",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189032230",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014605",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860403",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407023510",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603548221",
      "ndc_label_name": "Propranolol HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238207707",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090759301",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090709701",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000510",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268070015",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238207701",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959082730",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407023501",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292053010",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268070011",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118011003",
      "ndc_label_name": "Propranolol HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058711",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786003",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189007430",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629227501",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860409",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756009411",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058701",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118011009",
      "ndc_label_name": "Propranolol HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205044690",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292053001",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189032290",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117501",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335055404",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205049960",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756009412",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629227401",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046401",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335114001",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046303",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046301",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205044660",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000501",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046403",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788860406",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335055402",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335114002",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335055403",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804025830",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335199402",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046402",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425046302",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205044630",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117500",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189032260",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789049590",
      "ndc_label_name": "Propranolol HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378018310",
      "ndc_label_name": "Propranolol HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115166001",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115166003",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904670506",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591555501",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378018301",
      "ndc_label_name": "Propranolol HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904746861",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090762001",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014806",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353050860",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591555510",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904670561",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603548321",
      "ndc_label_name": "Propranolol HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999055560",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014801",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959021220",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090395306",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353096160",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603548332",
      "ndc_label_name": "Propranolol HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090710101",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904746806",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268070115",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066311",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687030601",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090395500",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261501",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090282900",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090762006",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070160",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407023601",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268070111",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059811",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066315",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261506",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090395301",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687030611",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090762000",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959021201",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959021210",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756009512",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959021250",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090329606",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090710106",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205059030",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289023360",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289023312",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959021245",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789042360",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289023390",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760026260",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407023610",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008205",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779109",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289023330",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959021260",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098760",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760054560",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760073160",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289023301",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098770",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008204",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687059801",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629227701",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000610",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788779103",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788859509",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629227601",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788859503",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117608",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335066102",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335237105",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292053201",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292053210",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117603",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238207801",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033960",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610033945",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098780",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238207807",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789042330",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117600",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789042390",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756009511",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117601",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335008202",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000601",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098753",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789028030",
      "ndc_label_name": "Propranolol HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591555610",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603548421",
      "ndc_label_name": "Propranolol HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090710406",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115166103",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440823294",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090286906",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115166101",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378018401",
      "ndc_label_name": "Propranolol HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407023701",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603548432",
      "ndc_label_name": "Propranolol HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066415",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378018410",
      "ndc_label_name": "Propranolol HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063064730",
      "ndc_label_name": "Propranolol HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090761806",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591555601",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440823230",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407023710",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008460",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862003",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440823290",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063064790",
      "ndc_label_name": "Propranolol HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268070215",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014906",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090286901",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735001",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268066411",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862006",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090014901",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353070660",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919080830",
      "ndc_label_name": "Propranolol HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268070211",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436431402",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117701",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629227901",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862009",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090710401",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090761801",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238207901",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629227801",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862001",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959089560",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735003",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292053410",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060901",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789037290",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000701",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735009",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060911",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756029611",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735006",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292053401",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238207907",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047203",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756029651",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804007330",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117700",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000710",
      "ndc_label_name": "Propranolol HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115169301",
      "ndc_label_name": "Propranolol HCl TABLET 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292053601",
      "ndc_label_name": "Propranolol HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629228001",
      "ndc_label_name": "Propranolol HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378018701",
      "ndc_label_name": "Propranolol HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407023901",
      "ndc_label_name": "Propranolol HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603548521",
      "ndc_label_name": "Propranolol HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000801",
      "ndc_label_name": "Propranolol HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756029711",
      "ndc_label_name": "Propranolol HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238208001",
      "ndc_label_name": "Propranolol HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117801",
      "ndc_label_name": "Propranolol HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603548621",
      "ndc_label_name": "Propranolol HCl TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407023805",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756029811",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115166202",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440823490",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378018505",
      "ndc_label_name": "Propranolol HCl TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115166201",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378018501",
      "ndc_label_name": "Propranolol HCl TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407023801",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238208101",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440823494",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591555705",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00603548628",
      "ndc_label_name": "Propranolol HCl TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292053801",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591555701",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292053850",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629228201",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000905",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629228101",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756029851",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238208105",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335095503",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83980000901",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117901",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162117905",
      "ndc_label_name": "Propranolol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752017110",
      "ndc_label_name": "Propylthiouracil Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253065111",
      "ndc_label_name": "Propylthiouracil TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162207202",
      "ndc_label_name": "Propylthiouracil Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228234810",
      "ndc_label_name": "Propylthiouracil Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480924201",
      "ndc_label_name": "Propylthiouracil Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342031411",
      "ndc_label_name": "Propylthiouracil Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67253065110",
      "ndc_label_name": "Propylthiouracil TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084096425",
      "ndc_label_name": "Propylthiouracil TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084096495",
      "ndc_label_name": "Propylthiouracil TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135060690",
      "ndc_label_name": "Propylthiouracil Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162207201",
      "ndc_label_name": "Propylthiouracil Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335290101",
      "ndc_label_name": "Propylthiouracil Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105054701",
      "ndc_label_name": "Proscar TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105054706",
      "ndc_label_name": "Proscar TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105054715",
      "ndc_label_name": "Proscar TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105054702",
      "ndc_label_name": "Proscar TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289093630",
      "ndc_label_name": "Proscar TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "78206015301",
      "ndc_label_name": "Proscar Tablet 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66105054703",
      "ndc_label_name": "Proscar TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "78206015302",
      "ndc_label_name": "Proscar Tablet 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980015901",
      "ndc_label_name": "Protriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054021125",
      "ndc_label_name": "Protriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806009730",
      "ndc_label_name": "Protriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794000702",
      "ndc_label_name": "Protriptyline HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980015801",
      "ndc_label_name": "Protriptyline HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806009630",
      "ndc_label_name": "Protriptyline HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054021025",
      "ndc_label_name": "Protriptyline HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42794000402",
      "ndc_label_name": "Protriptyline HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00276060328",
      "ndc_label_name": "Proxivol Gel 2 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00527530264",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672416508",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121093304",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574110416",
      "ndc_label_name": "Pseudoeph-Bromphen-DM SYRUP 30-2-10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192060704",
      "ndc_label_name": "Pseudoeph-Bromphen-DM SYRUP 30-2-10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192060716",
      "ndc_label_name": "Pseudoeph-Bromphen-DM SYRUP 30-2-10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192063004",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121093316",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192060740",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862053504",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527530270",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629205901",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991084704",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090562500",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192063016",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574110404",
      "ndc_label_name": "Pseudoeph-Bromphen-DM SYRUP 30-2-10 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187093004",
      "ndc_label_name": "Pseudoeph-Bromphen-DM SYRUP 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629205801",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862053516",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629861501",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432027504",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432027516",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135030248",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192060705",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788786101",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629208501",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135030224",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452047855",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629861601",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135030205",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907020716",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672416509",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788712301",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162112302",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930002618",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452047888",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930002643",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135030247",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991084716",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629208601",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907020704",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836601",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797501",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162112304",
      "ndc_label_name": "Pseudoeph-Bromphen-DM Syrup 30-2-10 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802010752",
      "ndc_label_name": "Pseudoephedrine HCl ER Tablet Extended Release 12 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660020469",
      "ndc_label_name": "Pseudoephedrine HCl ER Tablet Extended Release 12 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660049221",
      "ndc_label_name": "Pseudoephedrine HCl ER Tablet Extended Release 12 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51660020421",
      "ndc_label_name": "Pseudoephedrine HCl ER Tablet Extended Release 12 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090555400",
      "ndc_label_name": "Pseudoephedrine HCl ER Tablet Extended Release 12 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904740915",
      "ndc_label_name": "Pseudoephedrine HCl ER Tablet Extended Release 12 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000060101",
      "ndc_label_name": "Pseudoephedrine HCl ER Tablet Extended Release 12 Hour 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959051520",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45802043262",
      "ndc_label_name": "Pseudoephedrine HCl TABLET 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440824515",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71205019724",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440824524",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440824520",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090561501",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959051515",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50844021114",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959051530",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440824530",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904699061",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959026024",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440824624",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959026000",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440824630",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959026030",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904690706",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959026040",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959026020",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959026025",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267018730",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267018720",
      "ndc_label_name": "Pseudoephedrine HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55111079835",
      "ndc_label_name": "Pseudoephedrine-guaiFENesin ER Tablet Extended Release 12 Hour 60-600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536133336",
      "ndc_label_name": "Pseudoephedrine-guaiFENesin ER Tablet Extended Release 12 Hour 60-600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536133321",
      "ndc_label_name": "Pseudoephedrine-guaiFENesin ER Tablet Extended Release 12 Hour 60-600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55111079818",
      "ndc_label_name": "Pseudoephedrine-guaiFENesin ER Tablet Extended Release 12 Hour 60-600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63187096018",
      "ndc_label_name": "Pseudoephedrine-guaiFENesin ER Tablet Extended Release 12 Hour 60-600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55111079836",
      "ndc_label_name": "Pseudoephedrine-guaiFENesin ER Tablet Extended Release 12 Hour 60-600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "55111079841",
      "ndc_label_name": "Pseudoephedrine-guaiFENesin ER Tablet Extended Release 12 Hour 60-600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40985027024",
      "ndc_label_name": "Psyllium Fiber Capsule 0.52 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50242010040",
      "ndc_label_name": "Pulmozyme Solution 2.5 MG/2.5ML Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242010039",
      "ndc_label_name": "Pulmozyme Solution 2.5 MG/2.5ML Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "41415017077",
      "ndc_label_name": "PX Iron Tablet 200 (65 Fe) MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00054081222",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348081660",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135073501",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954048420",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054081229",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054081221",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054081225",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135073560",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954048440",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687078911",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090052100",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090596300",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135073590",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342044711",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342044715",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687078901",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090052000",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748001201",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954048430",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748001206",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748001205",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748001209",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954048410",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748001211",
      "ndc_label_name": "Pyrazinamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115351101",
      "ndc_label_name": "Pyridostigmine Bromide TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739096940",
      "ndc_label_name": "pyRIDostigmine Bromide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559047001",
      "ndc_label_name": "pyRIDostigmine Bromide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904662261",
      "ndc_label_name": "Pyridostigmine Bromide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407059030",
      "ndc_label_name": "pyRIDostigmine Bromide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084049401",
      "ndc_label_name": "Pyridostigmine Bromide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065901",
      "ndc_label_name": "Pyridostigmine Bromide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050201",
      "ndc_label_name": "Pyridostigmine Bromide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084049411",
      "ndc_label_name": "Pyridostigmine Bromide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050211",
      "ndc_label_name": "Pyridostigmine Bromide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382065906",
      "ndc_label_name": "Pyridostigmine Bromide TABLET 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682030210",
      "ndc_label_name": "pyRIDostigmine Bromide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930002890",
      "ndc_label_name": "Pyridostigmine Bromide Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440855730",
      "ndc_label_name": "Pyridoxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959021800",
      "ndc_label_name": "Pyridoxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440255730",
      "ndc_label_name": "Pyridoxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959021802",
      "ndc_label_name": "Pyridoxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72789016030",
      "ndc_label_name": "Pyridoxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135013930",
      "ndc_label_name": "Pyridoxine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43063094430",
      "ndc_label_name": "Pyridoxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440855792",
      "ndc_label_name": "Pyridoxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959021850",
      "ndc_label_name": "Pyridoxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959021820",
      "ndc_label_name": "Pyridoxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135013910",
      "ndc_label_name": "Pyridoxine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "10135016713",
      "ndc_label_name": "Pyridoxine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959021860",
      "ndc_label_name": "Pyridoxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629366001",
      "ndc_label_name": "Pyridoxine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959021830",
      "ndc_label_name": "Pyridoxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629366002",
      "ndc_label_name": "Pyridoxine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999089430",
      "ndc_label_name": "Pyridoxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "63629366003",
      "ndc_label_name": "Pyridoxine HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61314065494",
      "ndc_label_name": "Pyzchiva Solution 130 MG/26ML Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314065101",
      "ndc_label_name": "Pyzchiva Solution Prefilled Syringe 45 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83457065101",
      "ndc_label_name": "Pyzchiva Solution Prefilled Syringe 45 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83457065201",
      "ndc_label_name": "Pyzchiva Solution Prefilled Syringe 90 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314065201",
      "ndc_label_name": "Pyzchiva Solution Prefilled Syringe 90 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52652300101",
      "ndc_label_name": "Qbrelis SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50228038160",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742063660",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001059906",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135065660",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729010912",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013602",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904680261",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007460",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862087460",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189048130",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300030916",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629247901",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342013409",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407080060",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817016160",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001051206",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180061307",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189058630",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742063760",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135065760",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729009512",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629248001",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904680361",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342013509",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189051930",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760086630",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013702",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228038260",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300031016",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001051306",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007560",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407080160",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817016260",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862087560",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180061407",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001060006",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189048230",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629248101",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407080260",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729009612",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862087660",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300031116",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904680461",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742063860",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817016360",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090319800",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135065860",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228038360",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001051406",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013802",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342013609",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180061507",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007660",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001060106",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742063960",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342013709",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228038460",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904680561",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817016460",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180061607",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135065960",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729009712",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629248201",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007760",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862087760",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013902",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300031216",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189064230",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001051506",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407080360",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189048330",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001060206",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904680161",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862087360",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007360",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729013212",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742063560",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001059806",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300030816",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001051106",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407079960",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228038060",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013502",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629247801",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817016060",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180061207",
      "ndc_label_name": "QUEtiapine Fumarate ER Tablet Extended Release 24 Hour 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714037701",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722076601",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714045402",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093816201",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714037702",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571071901",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904664061",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291069790",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714045401",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291069710",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014717",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781534401",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014701",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001115",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571071910",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001130",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300014901",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078545",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353015560",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353015515",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014710",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078515",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001160",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353015553",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081830",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078560",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081815",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353015530",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342010111",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090337700",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078530",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081845",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063211",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081816",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547052010",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078516",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353015545",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090330",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090374901",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081853",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076230",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090681200",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335090488",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547052011",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078553",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629477602",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090588400",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081860",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877025010",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090681201",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407006810",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335090418",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090291400",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877025001",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687034911",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090339200",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788741203",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180044701",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018400",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700090390",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090294400",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796006",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180044703",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090374900",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839003",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788741201",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874508",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629477604",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090337701",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796009",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874503",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063215",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839006",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839001",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804009430",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862049101",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090588401",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839009",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013653",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407006801",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013660",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041303",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041302",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796001",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687034901",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874501",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009009710",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862049199",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629477605",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874506",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739066510",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874509",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018408",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335146202",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796003",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788741206",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788839008",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013630",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335242802",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013615",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013616",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034060",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804002030",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788741208",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013645",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788741209",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789025560",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788796008",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034030",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425041301",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722076701",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353016153",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781534601",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093816301",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571072010",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014810",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714045501",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090330300",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342010311",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095730",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904664161",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571072001",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714037801",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353016115",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300015001",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629496405",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078653",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407006905",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291069850",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014817",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014801",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335090518",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090269000",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739067710",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081430",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687036011",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291069890",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353016130",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078630",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063311",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063315",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180044801",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353095718",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018203",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090283000",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081453",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081416",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687036001",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862049301",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012830",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547052111",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874603",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090296600",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547052110",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335090588",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629496401",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877024610",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862049399",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090292600",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205040130",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180044802",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018200",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090747100",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795001",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874609",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795009",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090492700",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012815",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874601",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874606",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407006901",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012816",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788885903",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788885901",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076330",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012853",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788885906",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070215",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429041601",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788948701",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877024601",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788885909",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629496404",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788948708",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795006",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009009801",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795003",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610070230",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788795008",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189046530",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874608",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788885908",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788948703",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788948706",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788948709",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093206301",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291069590",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714037501",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781534301",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714037502",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081330",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571071701",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904663861",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571071710",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353015353",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547051811",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014517",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714045201",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407006601",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300014710",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014510",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014501",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078830",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333300",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353015330",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714045202",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187045230",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090283100",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722076401",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353015360",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081353",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877024210",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081360",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300014701",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629493904",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063015",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009911",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078853",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090293200",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205082630",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335090218",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291069510",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180044503",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629493902",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353078860",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547051810",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018500",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335156201",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090333301",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407006610",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876401",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862048999",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090280800",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335090288",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718503",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335156202",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700094130",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687032701",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876406",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876403",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063011",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090230700",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718506",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876409",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187045203",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687032711",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882309",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014053",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076430",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700094190",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718508",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044630",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018508",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629493903",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788806503",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877024201",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862048901",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180044501",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788806506",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718501",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788806508",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882303",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518103400",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788806501",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718509",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788806590",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014030",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882306",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882308",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014060",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788876408",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009009501",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882301",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781534701",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014917",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571072106",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014910",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571072101",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093816401",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014901",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904664261",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291069950",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291069990",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722076801",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353015053",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014912",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571072110",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018300",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300015116",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353084718",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007005",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718401",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687037101",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300015101",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714037901",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718406",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342010409",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335090688",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007060",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853006",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877024710",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547052206",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714045601",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718408",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353000418",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090398300",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722076860",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002630",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877024733",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018306",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063415",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834803",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335090618",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063411",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862049460",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335043202",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877024738",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180044902",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862049499",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834806",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335090686",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687037111",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018303",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335227801",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718409",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877024760",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180044907",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788844403",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180044901",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718403",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834809",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788844409",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788844406",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335043203",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853003",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853009",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335077201",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610012718",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002690",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335043201",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335043204",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335969701",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335969702",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353085218",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571072250",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714038001",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571072201",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904664361",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722076905",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781534801",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093816501",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877024810",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729015001",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090633700",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722076901",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729015010",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291070050",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714045701",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180045002",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014118",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300015201",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063515",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353000818",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547052310",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291070090",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729015016",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205040230",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090547300",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342010511",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862049505",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063511",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038201",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007105",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335090718",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407007101",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180045001",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862049501",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518250201",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687038211",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205003190",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877024801",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335090788",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018100",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610053887",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018103",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 400 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090173300",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014187",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189047730",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090337000",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904663961",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187021930",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014601",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781534201",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571071801",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571071810",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093816601",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714037602",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714037601",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781309",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014617",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090402201",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729014610",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862049099",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714045301",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342010011",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714045302",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877809",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547051911",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629484103",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547051910",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781301",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300014801",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291069610",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090334201",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335092602",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335090388",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862049001",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407006710",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877803",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300014810",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291069690",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063115",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877806",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407006701",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877024901",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687033811",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205078830",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722076501",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877024910",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687033801",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009009610",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629484102",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781306",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180044603",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018008",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335090318",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877801",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919051930",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180044601",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781303",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335242201",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036660",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718603",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268063111",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718608",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629484101",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718609",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781308",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877808",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425010703",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036630",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018000",
      "ndc_label_name": "QUEtiapine Fumarate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425014303",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718601",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018603",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018403",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718606",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335135302",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026607",
      "ndc_label_name": "QUEtiapine Fumarate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018805",
      "ndc_label_name": "Quinapril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187087430",
      "ndc_label_name": "Quinapril HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135048590",
      "ndc_label_name": "Quinapril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264300",
      "ndc_label_name": "Quinapril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180055709",
      "ndc_label_name": "Quinapril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862061890",
      "ndc_label_name": "Quinapril HCl TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041109",
      "ndc_label_name": "Quinapril HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205048430",
      "ndc_label_name": "Quinapril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205063530",
      "ndc_label_name": "Quinapril HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862061990",
      "ndc_label_name": "Quinapril HCl TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440827006",
      "ndc_label_name": "Quinapril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090211601",
      "ndc_label_name": "Quinapril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084089925",
      "ndc_label_name": "Quinapril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041209",
      "ndc_label_name": "Quinapril HCl TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135048690",
      "ndc_label_name": "Quinapril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090211600",
      "ndc_label_name": "Quinapril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084089995",
      "ndc_label_name": "Quinapril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018705",
      "ndc_label_name": "Quinapril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180055809",
      "ndc_label_name": "Quinapril HCl Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440807206",
      "ndc_label_name": "Quinapril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041309",
      "ndc_label_name": "Quinapril HCl TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001026005",
      "ndc_label_name": "Quinapril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090211701",
      "ndc_label_name": "Quinapril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090211700",
      "ndc_label_name": "Quinapril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135048790",
      "ndc_label_name": "Quinapril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180055409",
      "ndc_label_name": "Quinapril HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862062090",
      "ndc_label_name": "Quinapril HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547041009",
      "ndc_label_name": "Quinapril HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135048460",
      "ndc_label_name": "Quinapril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001018905",
      "ndc_label_name": "Quinapril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862061790",
      "ndc_label_name": "Quinapril HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180055609",
      "ndc_label_name": "Quinapril HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762022201",
      "ndc_label_name": "Quinapril-Hydrochlorothiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135066790",
      "ndc_label_name": "Quinapril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862016190",
      "ndc_label_name": "Quinapril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862016290",
      "ndc_label_name": "Quinapril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762022001",
      "ndc_label_name": "Quinapril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862016230",
      "ndc_label_name": "Quinapril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135066890",
      "ndc_label_name": "Quinapril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135066990",
      "ndc_label_name": "Quinapril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762022301",
      "ndc_label_name": "Quinapril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762522509",
      "ndc_label_name": "Quinapril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862016390",
      "ndc_label_name": "Quinapril-hydroCHLOROthiazide Tablet 20-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806051230",
      "ndc_label_name": "quiNIDine Sulfate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11822489880",
      "ndc_label_name": "RA Calcium 600/Vit D/Minerals Tablet Chewable 600-400 MG-UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11822372290",
      "ndc_label_name": "RA Ear Drying Agent Liquid 95-5 % Otic",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11822332190",
      "ndc_label_name": "RA Glycerin Adult Suppository 80.7 % Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11822332150",
      "ndc_label_name": "RA Glycerin Adult Suppository 80.7 % Rectal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11822098558",
      "ndc_label_name": "RA Lice Treatment Liquid 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11822098558",
      "ndc_label_name": "RA Lice Treatment LOTION 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11822880980",
      "ndc_label_name": "RA Melatonin Tablet 3-2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11822032300",
      "ndc_label_name": "RA Miconazole 3 Combo Pack App Kit 200 & 2 MG-% (9GM) Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440529530",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440529581",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093729056",
      "ndc_label_name": "Raloxifene HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440529505",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268069415",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093729001",
      "ndc_label_name": "Raloxifene HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025360",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440529590",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904690204",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598050501",
      "ndc_label_name": "Raloxifene HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440529560",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862070930",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241001011",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714021301",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090336301",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714021303",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090336300",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598050530",
      "ndc_label_name": "Raloxifene HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162005703",
      "ndc_label_name": "Raloxifene HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097082502",
      "ndc_label_name": "Raloxifene HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268069411",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714021302",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090707301",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598050510",
      "ndc_label_name": "Raloxifene HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610052460",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687026611",
      "ndc_label_name": "Raloxifene HCl TABLET 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993066102",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097082507",
      "ndc_label_name": "Raloxifene HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162241801",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291072610",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687026621",
      "ndc_label_name": "Raloxifene HCl TABLET 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610050460",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162241800",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162005710",
      "ndc_label_name": "Raloxifene HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005360",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241001022",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162241803",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090386601",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72241001005",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993066130",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282025605",
      "ndc_label_name": "Raloxifene HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090617701",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282025630",
      "ndc_label_name": "Raloxifene HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097082515",
      "ndc_label_name": "Raloxifene HCl TABLET 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862070901",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993066188",
      "ndc_label_name": "Raloxifene HCl Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001042800",
      "ndc_label_name": "Ramipril Capsule 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729015201",
      "ndc_label_name": "Ramipril Capsule 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382014406",
      "ndc_label_name": "Ramipril CAPSULE 1.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237022201",
      "ndc_label_name": "Ramipril CAPSULE 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722027101",
      "ndc_label_name": "Ramipril Capsule 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111043890",
      "ndc_label_name": "Ramipril Capsule 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862047401",
      "ndc_label_name": "Ramipril CAPSULE 1.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135027190",
      "ndc_label_name": "Ramipril Capsule 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237022230",
      "ndc_label_name": "Ramipril CAPSULE 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135027101",
      "ndc_label_name": "Ramipril Capsule 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067001",
      "ndc_label_name": "Ramipril Capsule 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135027130",
      "ndc_label_name": "Ramipril Capsule 1.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862047430",
      "ndc_label_name": "Ramipril CAPSULE 1.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729015501",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573000",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090112001",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722027410",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722027405",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722027401",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135027405",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090112000",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729015516",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111044105",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407070901",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237022505",
      "ndc_label_name": "Ramipril CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090257701",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090257700",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067305",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760057190",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573001",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081630",
      "ndc_label_name": "Ramipril CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118059109",
      "ndc_label_name": "Ramipril CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081690",
      "ndc_label_name": "Ramipril CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090682900",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237022501",
      "ndc_label_name": "Ramipril CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862047705",
      "ndc_label_name": "Ramipril CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862047701",
      "ndc_label_name": "Ramipril CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090788700",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002990",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001043100",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187085430",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111044190",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180059110",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180059101",
      "ndc_label_name": "Ramipril CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001043103",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118059108",
      "ndc_label_name": "Ramipril CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067301",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760047790",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180059102",
      "ndc_label_name": "Ramipril CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919083330",
      "ndc_label_name": "Ramipril CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382014701",
      "ndc_label_name": "Ramipril CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135027401",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135027490",
      "ndc_label_name": "Ramipril Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180059109",
      "ndc_label_name": "Ramipril CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722027201",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135027205",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729015301",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305900",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090594700",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862047501",
      "ndc_label_name": "Ramipril CAPSULE 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729015316",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722027210",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180058909",
      "ndc_label_name": "Ramipril CAPSULE 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180058902",
      "ndc_label_name": "Ramipril CAPSULE 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237022305",
      "ndc_label_name": "Ramipril CAPSULE 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407070701",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237022301",
      "ndc_label_name": "Ramipril CAPSULE 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205008090",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722027205",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111043990",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382014501",
      "ndc_label_name": "Ramipril CAPSULE 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135027201",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135027290",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001042900",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187091530",
      "ndc_label_name": "Ramipril CAPSULE 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067101",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090135400",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789041590",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180058901",
      "ndc_label_name": "Ramipril CAPSULE 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067105",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387300",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180058910",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111043905",
      "ndc_label_name": "Ramipril Capsule 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187091590",
      "ndc_label_name": "Ramipril CAPSULE 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862047505",
      "ndc_label_name": "Ramipril CAPSULE 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722027301",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090111801",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722027305",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729015401",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722027310",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729015416",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118059008",
      "ndc_label_name": "Ramipril CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090111800",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090247500",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407070801",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090459700",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180059001",
      "ndc_label_name": "Ramipril CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111044005",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090247501",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118059009",
      "ndc_label_name": "Ramipril CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567300",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090459701",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180059009",
      "ndc_label_name": "Ramipril CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180059002",
      "ndc_label_name": "Ramipril CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567301",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919015730",
      "ndc_label_name": "Ramipril CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760048190",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760047690",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237022401",
      "ndc_label_name": "Ramipril CAPSULE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111044090",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862047605",
      "ndc_label_name": "Ramipril CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382014601",
      "ndc_label_name": "Ramipril CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135027301",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135027390",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067205",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135027305",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180059010",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237022405",
      "ndc_label_name": "Ramipril CAPSULE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862047601",
      "ndc_label_name": "Ramipril CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282067201",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001043000",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001043003",
      "ndc_label_name": "Ramipril Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228042460",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877052660",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300029716",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241012602",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722066960",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086800",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462032060",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268072313",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304001860",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367029460",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385096460",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241012605",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268072311",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73141002202",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771042460",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72319002202",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086860",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756070460",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963041906",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291077460",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407022660",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086855",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651001060",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571032560",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086878",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086890",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578006514",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086830",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086872",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385096360",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45963041806",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687054911",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241012505",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086755",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304001760",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904750604",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241012502",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086790",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687054921",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739022901",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300029616",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610097142",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610032283",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291077360",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228042360",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77771042360",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086700",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571032460",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722066860",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578006414",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051883",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877052560",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268072211",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462031960",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086730",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051842",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268072215",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011860",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367029360",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407022560",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70756070360",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651000960",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086772",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086760",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205086778",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72319002102",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73141002102",
      "ndc_label_name": "Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "22066000511",
      "ndc_label_name": "Rapid Response COVID-19 Kit In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "44087332209",
      "ndc_label_name": "Rebif Rebidose Solution Auto-Injector 22 MCG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44087332201",
      "ndc_label_name": "Rebif Rebidose Solution Auto-Injector 22 MCG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44087334401",
      "ndc_label_name": "Rebif Rebidose Solution Auto-Injector 44 MCG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44087334409",
      "ndc_label_name": "Rebif Rebidose Solution Auto-Injector 44 MCG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44087018801",
      "ndc_label_name": "Rebif Rebidose Titration Pack Solution Auto-injector 6X8.8 & 6X22 MCG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44087002203",
      "ndc_label_name": "Rebif Solution Prefilled Syringe 22 MCG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44087002209",
      "ndc_label_name": "Rebif Solution Prefilled Syringe 22 MCG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44087004409",
      "ndc_label_name": "Rebif Solution Prefilled Syringe 44 MCG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44087004403",
      "ndc_label_name": "Rebif Solution Prefilled Syringe 44 MCG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44087882201",
      "ndc_label_name": "Rebif Titration Pack Solution Prefilled Syringe 6X8.8 & 6X22 MCG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093330416",
      "ndc_label_name": "Reclipsen TABLET 0.15-30 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093330428",
      "ndc_label_name": "Reclipsen TABLET 0.15-30 MG-MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006499541",
      "ndc_label_name": "Recombivax HB SUSPENSION 10 MCG/ML INJECTION",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006498100",
      "ndc_label_name": "Recombivax HB SUSPENSION 5 MCG/0.5ML INJECTION",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006409401",
      "ndc_label_name": "Recombivax HB Suspension Prefilled Syringe 10 MCG/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68784010812",
      "ndc_label_name": "Rectacort-HC SUPPOSITORY 25 MG Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00074016201",
      "ndc_label_name": "Rehydralyte SOLUTION ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70074040162",
      "ndc_label_name": "Rehydralyte SOLUTION ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00173068101",
      "ndc_label_name": "Relenza Diskhaler Aerosol Powder Breath Activated 5 MG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54569483000",
      "ndc_label_name": "Relenza Diskhaler Aerosol Powder Breath Activated 5 MG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "56151146104",
      "ndc_label_name": "ReliOn True Metrix Test Strips Strip In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151146101",
      "ndc_label_name": "ReliOn True Metrix Test Strips Strip In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33342024811",
      "ndc_label_name": "Repaglinide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629844701",
      "ndc_label_name": "Repaglinide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429048401",
      "ndc_label_name": "Repaglinide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135094690",
      "ndc_label_name": "Repaglinide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574024001",
      "ndc_label_name": "Repaglinide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991085301",
      "ndc_label_name": "Repaglinide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067001",
      "ndc_label_name": "Repaglinide TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162111201",
      "ndc_label_name": "Repaglinide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237015701",
      "ndc_label_name": "Repaglinide TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603081001",
      "ndc_label_name": "Repaglinide Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162255801",
      "ndc_label_name": "Repaglinide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574024101",
      "ndc_label_name": "Repaglinide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237015801",
      "ndc_label_name": "Repaglinide TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664074513",
      "ndc_label_name": "Repaglinide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664074588",
      "ndc_label_name": "Repaglinide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162111301",
      "ndc_label_name": "Repaglinide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342024911",
      "ndc_label_name": "Repaglinide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629844801",
      "ndc_label_name": "Repaglinide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429048501",
      "ndc_label_name": "Repaglinide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991085401",
      "ndc_label_name": "Repaglinide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687056011",
      "ndc_label_name": "Repaglinide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603081101",
      "ndc_label_name": "Repaglinide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135094790",
      "ndc_label_name": "Repaglinide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687056021",
      "ndc_label_name": "Repaglinide Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067101",
      "ndc_label_name": "Repaglinide TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237015901",
      "ndc_label_name": "Repaglinide TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603081201",
      "ndc_label_name": "Repaglinide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991085501",
      "ndc_label_name": "Repaglinide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574024201",
      "ndc_label_name": "Repaglinide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342025011",
      "ndc_label_name": "Repaglinide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629844901",
      "ndc_label_name": "Repaglinide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629919401",
      "ndc_label_name": "Repaglinide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664074713",
      "ndc_label_name": "Repaglinide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664074788",
      "ndc_label_name": "Repaglinide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862067201",
      "ndc_label_name": "Repaglinide TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135094890",
      "ndc_label_name": "Repaglinide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429048601",
      "ndc_label_name": "Repaglinide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162111401",
      "ndc_label_name": "Repaglinide Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72511077001",
      "ndc_label_name": "Repatha Pushtronex System Solution Cartridge 420 MG/3.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72511075001",
      "ndc_label_name": "Repatha Solution Prefilled Syringe 140 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72511050101",
      "ndc_label_name": "Repatha Solution Prefilled Syringe 140 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72511039301",
      "ndc_label_name": "Repatha SureClick Solution Auto-Injector 140 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72511076001",
      "ndc_label_name": "Repatha SureClick Solution Auto-Injector 140 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72511039302",
      "ndc_label_name": "Repatha SureClick Solution Auto-Injector 140 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72511076002",
      "ndc_label_name": "Repatha SureClick Solution Auto-Injector 140 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50486008296",
      "ndc_label_name": "Replacement Air Filter",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50486008252",
      "ndc_label_name": "Replacement Air Filter",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "38673005502",
      "ndc_label_name": "Replacement Filters",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373092904",
      "ndc_label_name": "Replacement Filters",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "83490041086",
      "ndc_label_name": "Replacement Filters",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00069131810",
      "ndc_label_name": "Retacrit Solution 10000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069131801",
      "ndc_label_name": "Retacrit Solution 10000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069130801",
      "ndc_label_name": "Retacrit Solution 10000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59353001010",
      "ndc_label_name": "Retacrit Solution 10000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59353001001",
      "ndc_label_name": "Retacrit Solution 10000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069130810",
      "ndc_label_name": "Retacrit Solution 10000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59353022010",
      "ndc_label_name": "Retacrit Solution 10000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59353022001",
      "ndc_label_name": "Retacrit Solution 10000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069130510",
      "ndc_label_name": "Retacrit Solution 2000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069130501",
      "ndc_label_name": "Retacrit Solution 2000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59353000201",
      "ndc_label_name": "Retacrit Solution 2000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59353000210",
      "ndc_label_name": "Retacrit Solution 2000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59353012010",
      "ndc_label_name": "Retacrit Solution 20000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069131110",
      "ndc_label_name": "Retacrit Solution 20000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069131101",
      "ndc_label_name": "Retacrit Solution 20000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59353012001",
      "ndc_label_name": "Retacrit Solution 20000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069130601",
      "ndc_label_name": "Retacrit Solution 3000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069130610",
      "ndc_label_name": "Retacrit Solution 3000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59353000301",
      "ndc_label_name": "Retacrit Solution 3000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59353000310",
      "ndc_label_name": "Retacrit Solution 3000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069130701",
      "ndc_label_name": "Retacrit Solution 4000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069130710",
      "ndc_label_name": "Retacrit Solution 4000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59353000401",
      "ndc_label_name": "Retacrit Solution 4000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59353000410",
      "ndc_label_name": "Retacrit Solution 4000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069130904",
      "ndc_label_name": "Retacrit Solution 40000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069130901",
      "ndc_label_name": "Retacrit Solution 40000 UNIT/ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "04351044010",
      "ndc_label_name": "Reusable Comfortseal Mask-LRG",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351024010",
      "ndc_label_name": "Reusable Comfortseal Mask-MED",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351034010",
      "ndc_label_name": "Reusable Comfortseal Mask-SML",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090158100",
      "ndc_label_name": "Reyataz Capsule 200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00003363112",
      "ndc_label_name": "Reyataz CAPSULE 200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356020760",
      "ndc_label_name": "Reyataz Capsule 200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00003362212",
      "ndc_label_name": "Reyataz CAPSULE 300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356011406",
      "ndc_label_name": "Reyataz Capsule 300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002898001",
      "ndc_label_name": "Rezvoglar KwikPen Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002898005",
      "ndc_label_name": "Rezvoglar KwikPen Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090643900",
      "ndc_label_name": "Rezvoglar KwikPen Solution Pen-Injector 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00562780500",
      "ndc_label_name": "RhoGAM Ultra-Filtered Plus Solution Prefilled Syringe 1500 UNIT Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00562780505",
      "ndc_label_name": "RhoGAM Ultra-Filtered Plus Solution Prefilled Syringe 1500 UNIT Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00562780501",
      "ndc_label_name": "RhoGAM Ultra-Filtered Plus Solution Prefilled Syringe 1500 UNIT Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00562780525",
      "ndc_label_name": "RhoGAM Ultra-Filtered Plus Solution Prefilled Syringe 1500 UNIT Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206030090",
      "ndc_label_name": "Rhophylac Solution Prefilled Syringe 1500 UNIT/2ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206030001",
      "ndc_label_name": "Rhophylac Solution Prefilled Syringe 1500 UNIT/2ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "44206030010",
      "ndc_label_name": "Rhophylac Solution Prefilled Syringe 1500 UNIT/2ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862029056",
      "ndc_label_name": "Ribavirin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862029018",
      "ndc_label_name": "Ribavirin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862029042",
      "ndc_label_name": "Ribavirin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862029070",
      "ndc_label_name": "Ribavirin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862029084",
      "ndc_label_name": "Ribavirin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382026012",
      "ndc_label_name": "Ribavirin Capsule 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382004603",
      "ndc_label_name": "Ribavirin Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862020768",
      "ndc_label_name": "Ribavirin Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806080101",
      "ndc_label_name": "rifAMPin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527139301",
      "ndc_label_name": "rifAMPin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440831060",
      "ndc_label_name": "rifAMPin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440831030",
      "ndc_label_name": "rifAMPin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658080130",
      "ndc_label_name": "rifAMPin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090263300",
      "ndc_label_name": "Rifampin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527139330",
      "ndc_label_name": "rifAMPin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407032201",
      "ndc_label_name": "rifAMPin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687057511",
      "ndc_label_name": "rifAMPin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407032230",
      "ndc_label_name": "rifAMPin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806080130",
      "ndc_label_name": "rifAMPin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135031530",
      "ndc_label_name": "rifAMPin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687057521",
      "ndc_label_name": "rifAMPin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748001530",
      "ndc_label_name": "rifAMPin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180065801",
      "ndc_label_name": "rifAMPin Capsule 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180065806",
      "ndc_label_name": "Rifampin CAPSULE 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440831120",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658080260",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440831130",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090496103",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527131530",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527131501",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904528261",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527131506",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806079901",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356048030",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806079960",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090570900",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407032360",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090096303",
      "ndc_label_name": "Rifampin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904731561",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090096403",
      "ndc_label_name": "Rifampin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090570903",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806079930",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065330",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058601",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065310",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407032330",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289038608",
      "ndc_label_name": "Rifampin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065340",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407032301",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629404201",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058611",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739041510",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748001801",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180065906",
      "ndc_label_name": "Rifampin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629404203",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748001830",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959065320",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180065907",
      "ndc_label_name": "Rifampin CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135031660",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61748001860",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180065901",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629404202",
      "ndc_label_name": "rifAMPin Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115191101",
      "ndc_label_name": "riMANTAdine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629355201",
      "ndc_label_name": "riMANTAdine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999092030",
      "ndc_label_name": "riMANTAdine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980015001",
      "ndc_label_name": "Risacal-D Tablet 105-81-120 MG-MG-UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50458030901",
      "ndc_label_name": "RisperDAL Consta Suspension Reconstituted ER 12.5 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458030911",
      "ndc_label_name": "RisperDAL Consta Suspension Reconstituted ER 12.5 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458030601",
      "ndc_label_name": "RisperDAL Consta Suspension Reconstituted ER 25 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458030611",
      "ndc_label_name": "RisperDAL Consta Suspension Reconstituted ER 25 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458030701",
      "ndc_label_name": "RisperDAL Consta Suspension Reconstituted ER 37.5 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458030711",
      "ndc_label_name": "RisperDAL Consta Suspension Reconstituted ER 37.5 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458030801",
      "ndc_label_name": "RisperDAL Consta Suspension Reconstituted ER 50 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458030811",
      "ndc_label_name": "RisperDAL Consta Suspension Reconstituted ER 50 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856067302",
      "ndc_label_name": "RisperiDONE SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458059601",
      "ndc_label_name": "RisperiDONE SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856067303",
      "ndc_label_name": "RisperiDONE SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054006344",
      "ndc_label_name": "risperiDONE Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808000201",
      "ndc_label_name": "risperiDONE Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135092943",
      "ndc_label_name": "risperiDONE Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335273301",
      "ndc_label_name": "risperiDONE Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856067301",
      "ndc_label_name": "RisperiDONE SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162203702",
      "ndc_label_name": "risperiDONE Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111057930",
      "ndc_label_name": "RisperiDONE SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559098130",
      "ndc_label_name": "risperiDONE Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162067384",
      "ndc_label_name": "RisperiDONE SOLUTION 1 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162203703",
      "ndc_label_name": "risperiDONE Solution 1 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291097450",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135060060",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904635761",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033950",
      "ndc_label_name": "RisperiDONE TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090334700",
      "ndc_label_name": "RisperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291090860",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904736061",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291090850",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020105",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084027001",
      "ndc_label_name": "RisperiDONE TABLET 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668003560",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205052030",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746022105",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020160",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668003505",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677000205",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241000206",
      "ndc_label_name": "RisperiDONE TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700089760",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382011205",
      "ndc_label_name": "RisperiDONE TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367036805",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241000250",
      "ndc_label_name": "RisperiDONE TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367036860",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291097460",
      "ndc_label_name": "risperiDONE Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547033906",
      "ndc_label_name": "RisperiDONE TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084027011",
      "ndc_label_name": "RisperiDONE TABLET 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382011214",
      "ndc_label_name": "RisperiDONE TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904736161",
      "ndc_label_name": "risperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241000350",
      "ndc_label_name": "RisperiDONE TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668003660",
      "ndc_label_name": "RisperiDONE TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291090960",
      "ndc_label_name": "RisperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904635861",
      "ndc_label_name": "risperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034050",
      "ndc_label_name": "RisperiDONE TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335013003",
      "ndc_label_name": "RisperiDONE TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668003605",
      "ndc_label_name": "RisperiDONE TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268069511",
      "ndc_label_name": "risperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020205",
      "ndc_label_name": "risperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034006",
      "ndc_label_name": "RisperiDONE TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020260",
      "ndc_label_name": "risperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291097550",
      "ndc_label_name": "risperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746022205",
      "ndc_label_name": "risperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367036905",
      "ndc_label_name": "risperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241000306",
      "ndc_label_name": "RisperiDONE TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335013002",
      "ndc_label_name": "RisperiDONE TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382011314",
      "ndc_label_name": "RisperiDONE TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677000305",
      "ndc_label_name": "risperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135060160",
      "ndc_label_name": "risperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090334400",
      "ndc_label_name": "RisperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367036960",
      "ndc_label_name": "risperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268069515",
      "ndc_label_name": "risperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291090950",
      "ndc_label_name": "RisperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187064230",
      "ndc_label_name": "risperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335013004",
      "ndc_label_name": "RisperiDONE TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382011305",
      "ndc_label_name": "RisperiDONE TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084027101",
      "ndc_label_name": "RisperiDONE TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291097560",
      "ndc_label_name": "risperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084027111",
      "ndc_label_name": "RisperiDONE TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959021960",
      "ndc_label_name": "risperiDONE Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335013001",
      "ndc_label_name": "RisperiDONE TABLET 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904635961",
      "ndc_label_name": "risperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668003705",
      "ndc_label_name": "RisperiDONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090807",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904736261",
      "ndc_label_name": "risperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291091050",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241000150",
      "ndc_label_name": "RisperiDONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353043260",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353043245",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241000106",
      "ndc_label_name": "RisperiDONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291091060",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090830",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668003760",
      "ndc_label_name": "RisperiDONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291097650",
      "ndc_label_name": "risperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075515",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054345",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075553",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075545",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291097660",
      "ndc_label_name": "risperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353043215",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090860",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054330",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075560",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335062602",
      "ndc_label_name": "risperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084027201",
      "ndc_label_name": "RisperiDONE TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268069611",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063025430",
      "ndc_label_name": "RisperiDONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034150",
      "ndc_label_name": "RisperiDONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353054360",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034106",
      "ndc_label_name": "RisperiDONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090278000",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020305",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382011414",
      "ndc_label_name": "RisperiDONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746022305",
      "ndc_label_name": "risperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063025460",
      "ndc_label_name": "RisperiDONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014560",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075530",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268069615",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135060260",
      "ndc_label_name": "risperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037005",
      "ndc_label_name": "risperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014515",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014530",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353043230",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677000405",
      "ndc_label_name": "risperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084027211",
      "ndc_label_name": "RisperiDONE TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090334100",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037060",
      "ndc_label_name": "risperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020360",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335062601",
      "ndc_label_name": "risperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919057260",
      "ndc_label_name": "RisperiDONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382011405",
      "ndc_label_name": "RisperiDONE TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610014545",
      "ndc_label_name": "RisperiDONE Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268069711",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241000406",
      "ndc_label_name": "RisperiDONE TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904636061",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025915",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291091150",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063930",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904736361",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353072015",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020460",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241000450",
      "ndc_label_name": "RisperiDONE TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291091160",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037160",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353072030",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034250",
      "ndc_label_name": "RisperiDONE TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668003805",
      "ndc_label_name": "RisperiDONE TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789046114",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746022405",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291097760",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291097750",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677000505",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075745",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020405",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668003860",
      "ndc_label_name": "RisperiDONE TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353072045",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268069715",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135060360",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084027301",
      "ndc_label_name": "RisperiDONE TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075715",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959094160",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721103",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353063915",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075730",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382011514",
      "ndc_label_name": "RisperiDONE TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037105",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084027311",
      "ndc_label_name": "RisperiDONE TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034206",
      "ndc_label_name": "RisperiDONE TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721106",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025930",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090334000",
      "ndc_label_name": "RisperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090267200",
      "ndc_label_name": "RisperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026445",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026430",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959094130",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721109",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382011505",
      "ndc_label_name": "RisperiDONE TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025945",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026415",
      "ndc_label_name": "risperiDONE Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241000550",
      "ndc_label_name": "RisperiDONE TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291091260",
      "ndc_label_name": "RisperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291091250",
      "ndc_label_name": "RisperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034306",
      "ndc_label_name": "RisperiDONE TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084027411",
      "ndc_label_name": "RisperiDONE TABLET 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034350",
      "ndc_label_name": "RisperiDONE TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904736461",
      "ndc_label_name": "risperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904636161",
      "ndc_label_name": "risperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268069811",
      "ndc_label_name": "RisperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353076630",
      "ndc_label_name": "RisperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291097850",
      "ndc_label_name": "risperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51129462402",
      "ndc_label_name": "risperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382011614",
      "ndc_label_name": "RisperiDONE TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382011605",
      "ndc_label_name": "RisperiDONE TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668003905",
      "ndc_label_name": "RisperiDONE TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668003960",
      "ndc_label_name": "RisperiDONE TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020505",
      "ndc_label_name": "RisperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268069815",
      "ndc_label_name": "RisperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241000506",
      "ndc_label_name": "RisperiDONE TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746022505",
      "ndc_label_name": "risperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037260",
      "ndc_label_name": "risperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610004530",
      "ndc_label_name": "RisperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291097860",
      "ndc_label_name": "risperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020560",
      "ndc_label_name": "RisperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037205",
      "ndc_label_name": "risperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135060460",
      "ndc_label_name": "risperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022630",
      "ndc_label_name": "RisperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084027401",
      "ndc_label_name": "RisperiDONE TABLET 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677000605",
      "ndc_label_name": "risperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022653",
      "ndc_label_name": "RisperiDONE Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241000606",
      "ndc_label_name": "RisperiDONE TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291097960",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904636261",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268069911",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084027701",
      "ndc_label_name": "RisperiDONE TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668004060",
      "ndc_label_name": "RisperiDONE TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904736561",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291091360",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353041215",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055015",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353041230",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677000705",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382011705",
      "ndc_label_name": "RisperiDONE TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241000650",
      "ndc_label_name": "RisperiDONE TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668004005",
      "ndc_label_name": "RisperiDONE TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055045",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353041245",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055060",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353041260",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075460",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024615",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353041218",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291091350",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034406",
      "ndc_label_name": "RisperiDONE TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075415",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075430",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353055030",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268069915",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024653",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547034450",
      "ndc_label_name": "RisperiDONE TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291097950",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020660",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024660",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135060560",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075416",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382011714",
      "ndc_label_name": "RisperiDONE TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353075445",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037305",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746022605",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024645",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037360",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084027711",
      "ndc_label_name": "RisperiDONE TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024630",
      "ndc_label_name": "risperiDONE Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884021252",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884021255",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629228301",
      "ndc_label_name": "risperiDONE Tablet Dispersible 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884031152",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629228401",
      "ndc_label_name": "RisperiDONE Tablet Dispersible 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020781",
      "ndc_label_name": "RisperiDONE Tablet Dispersible 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884031155",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746001032",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884031191",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884031555",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884031552",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090302900",
      "ndc_label_name": "RisperiDONE Tablet Dispersible 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020881",
      "ndc_label_name": "RisperiDONE Tablet Dispersible 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746002022",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884031591",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746003022",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884040152",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090300600",
      "ndc_label_name": "RisperiDONE Tablet Dispersible 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884040191",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746004022",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111047081",
      "ndc_label_name": "risperiDONE Tablet Dispersible 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884040291",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884040252",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884040391",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746005022",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884040352",
      "ndc_label_name": "RisperiDONE TABLET DISPERSIBLE 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111047181",
      "ndc_label_name": "RisperiDONE Tablet Dispersible 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722059730",
      "ndc_label_name": "Ritonavir Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687042025",
      "ndc_label_name": "Ritonavir Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687042095",
      "ndc_label_name": "Ritonavir Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054040713",
      "ndc_label_name": "Ritonavir Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862068730",
      "ndc_label_name": "Ritonavir Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097065502",
      "ndc_label_name": "Ritonavir Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378907216",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781731358",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714011701",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378907293",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781731331",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714011702",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991089999",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781040511",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781040503",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629206401",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710119801",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991089930",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710119807",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162074934",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629884601",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162161003",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781730431",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710119607",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378907016",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781730458",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991089799",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378907093",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991089730",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162082534",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714011502",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781030411",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714011501",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162160803",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629206501",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781030403",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710119601",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629206601",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710119701",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781730931",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714011601",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378907193",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781030511",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781730958",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378907116",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714011602",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710119707",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162082634",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47781030503",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162160903",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991089830",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991089899",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629880701",
      "ndc_label_name": "Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904710761",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342008915",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111035205",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991079306",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332006360",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064860",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111035260",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342008909",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687077711",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687057411",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687057401",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687077701",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135090060",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756014513",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756014586",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72241001103",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834013305",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834013360",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 1.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135090160",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342009009",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342009015",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991079406",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834013460",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111035360",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111035305",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332006460",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756014613",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756014686",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862064960",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834013405",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72241001203",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111035460",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 4.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111035405",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 4.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991079506",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 4.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342009109",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 4.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342009115",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 4.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135090260",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 4.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72241001303",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 4.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332006560",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 4.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756014713",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 4.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834013505",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 4.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756014786",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 4.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862065060",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 4.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834013560",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 4.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111035560",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834013605",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756014886",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862065160",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51991079606",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342009209",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72241001403",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342009215",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332006660",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135090360",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111035505",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62756014813",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834013660",
      "ndc_label_name": "Rivastigmine Tartrate Capsule 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944303002",
      "ndc_label_name": "Rixubis SOLUTION RECONSTITUTED 1000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944303202",
      "ndc_label_name": "Rixubis SOLUTION RECONSTITUTED 2000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944302602",
      "ndc_label_name": "Rixubis SOLUTION RECONSTITUTED 250 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944303402",
      "ndc_label_name": "Rixubis SOLUTION RECONSTITUTED 3000 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00944302802",
      "ndc_label_name": "Rixubis SOLUTION RECONSTITUTED 500 UNIT Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407068206",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877026206",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342008841",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378140496",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300031721",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093747243",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093747219",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300031781",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407068212",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335135206",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090206900",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237008834",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991035578",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090334300",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342008845",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877026218",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991035599",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282046318",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090774700",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919065612",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335135204",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407068203",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090336700",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205064412",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877026225",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237008863",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060012",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862060003",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462046640",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462046699",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407068218",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189025812",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097086685",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189025818",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746041519",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189044718",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619011204",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804020212",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097086617",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282046306",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619011205",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300031621",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991035499",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378140396",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093747143",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342008741",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862059903",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300031681",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093747119",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407068103",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462046540",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919039418",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189051218",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407068112",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282046206",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342008745",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237008734",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407068106",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619011104",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097086517",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237008763",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407068118",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877026125",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862059912",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097086585",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746041419",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031618",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991035478",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877026118",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012618",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82619011105",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877026106",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282046218",
      "ndc_label_name": "Rizatriptan Benzoate TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462046599",
      "ndc_label_name": "Rizatriptan Benzoate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009402",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991036378",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300026981",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300026991",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009441",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700094218",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407068003",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009472",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407068018",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205039806",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009445",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862062603",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009452",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335181902",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991036399",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009473",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462046840",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452015773",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452015774",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862062612",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237008663",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205055706",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060918",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189034109",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862062690",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462046806",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425053501",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009345",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300026881",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009372",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237008563",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862062512",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009302",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009373",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009341",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991036278",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300026891",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407067918",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009352",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462046740",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407067903",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862062503",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700095818",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991036299",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462046706",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862062590",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452015673",
      "ndc_label_name": "Rizatriptan Benzoate TABLET DISPERSIBLE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452015674",
      "ndc_label_name": "Rizatriptan Benzoate Tablet Dispersible 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353019409",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547059510",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904637361",
      "ndc_label_name": "ROPINIRole HCl TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378552501",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729023201",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687057701",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353025809",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135067301",
      "ndc_label_name": "ROPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547026810",
      "ndc_label_name": "ROPINIRole HCl TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090133000",
      "ndc_label_name": "ROPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090182200",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353092009",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429081701",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071080630",
      "ndc_label_name": "ROPINIRole HCl TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919056430",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090480400",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547026850",
      "ndc_label_name": "ROPINIRole HCl TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090480300",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036430",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074111",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687057711",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332003031",
      "ndc_label_name": "ROPINIRole HCl TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189041630",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118025309",
      "ndc_label_name": "ROPINIRole HCl TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074115",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205082530",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462025301",
      "ndc_label_name": "ROPINIRole HCl TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452035620",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729023301",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378555001",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135067401",
      "ndc_label_name": "ROPINIRole HCl Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547026910",
      "ndc_label_name": "ROPINIRole HCl TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547026950",
      "ndc_label_name": "ROPINIRole HCl TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074211",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332003131",
      "ndc_label_name": "ROPINIRole HCl TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118025403",
      "ndc_label_name": "ROPINIRole HCl TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429081801",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353019509",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353026509",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462025401",
      "ndc_label_name": "ROPINIRole HCl TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118025409",
      "ndc_label_name": "ROPINIRole HCl TABLET 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547059610",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162220001",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074215",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452035720",
      "ndc_label_name": "rOPINIRole HCl Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135067501",
      "ndc_label_name": "ROPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378550101",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353019609",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729023401",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353026609",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547027050",
      "ndc_label_name": "ROPINIRole HCl TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090468401",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904637461",
      "ndc_label_name": "ROPINIRole HCl TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058801",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090468400",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090330401",
      "ndc_label_name": "ROPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353091209",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335143401",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090330400",
      "ndc_label_name": "ROPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452035820",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547059710",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074311",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118025503",
      "ndc_label_name": "ROPINIRole HCl TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429081901",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547027010",
      "ndc_label_name": "ROPINIRole HCl TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687058811",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074315",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090434801",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332003231",
      "ndc_label_name": "ROPINIRole HCl TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462025501",
      "ndc_label_name": "ROPINIRole HCl TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118025509",
      "ndc_label_name": "ROPINIRole HCl TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022230",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189022260",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189049430",
      "ndc_label_name": "rOPINIRole HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135067601",
      "ndc_label_name": "ROPINIRole HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547059810",
      "ndc_label_name": "rOPINIRole HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452035920",
      "ndc_label_name": "rOPINIRole HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353091109",
      "ndc_label_name": "rOPINIRole HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074411",
      "ndc_label_name": "rOPINIRole HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118025603",
      "ndc_label_name": "ROPINIRole HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729023501",
      "ndc_label_name": "rOPINIRole HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378550201",
      "ndc_label_name": "rOPINIRole HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353019809",
      "ndc_label_name": "rOPINIRole HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335116701",
      "ndc_label_name": "rOPINIRole HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074415",
      "ndc_label_name": "rOPINIRole HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547027150",
      "ndc_label_name": "ROPINIRole HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429082001",
      "ndc_label_name": "rOPINIRole HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547027110",
      "ndc_label_name": "ROPINIRole HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118025609",
      "ndc_label_name": "ROPINIRole HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332003331",
      "ndc_label_name": "ROPINIRole HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353026709",
      "ndc_label_name": "rOPINIRole HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462025601",
      "ndc_label_name": "ROPINIRole HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629497101",
      "ndc_label_name": "rOPINIRole HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118025709",
      "ndc_label_name": "ROPINIRole HCl TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378550301",
      "ndc_label_name": "rOPINIRole HCl Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729023601",
      "ndc_label_name": "rOPINIRole HCl Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135067701",
      "ndc_label_name": "ROPINIRole HCl Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462025701",
      "ndc_label_name": "ROPINIRole HCl TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429082101",
      "ndc_label_name": "rOPINIRole HCl Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547027210",
      "ndc_label_name": "ROPINIRole HCl TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332003431",
      "ndc_label_name": "ROPINIRole HCl TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919078030",
      "ndc_label_name": "rOPINIRole HCl Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118025703",
      "ndc_label_name": "ROPINIRole HCl TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547059910",
      "ndc_label_name": "rOPINIRole HCl Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452036020",
      "ndc_label_name": "rOPINIRole HCl Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547060010",
      "ndc_label_name": "rOPINIRole HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547027310",
      "ndc_label_name": "ROPINIRole HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090206800",
      "ndc_label_name": "ROPINIRole HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135067801",
      "ndc_label_name": "ROPINIRole HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729023701",
      "ndc_label_name": "rOPINIRole HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118025809",
      "ndc_label_name": "ROPINIRole HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429082201",
      "ndc_label_name": "rOPINIRole HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378550401",
      "ndc_label_name": "rOPINIRole HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452036120",
      "ndc_label_name": "rOPINIRole HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090744500",
      "ndc_label_name": "rOPINIRole HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462025801",
      "ndc_label_name": "ROPINIRole HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118025803",
      "ndc_label_name": "ROPINIRole HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332003531",
      "ndc_label_name": "ROPINIRole HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378550501",
      "ndc_label_name": "rOPINIRole HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135067901",
      "ndc_label_name": "ROPINIRole HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118025909",
      "ndc_label_name": "ROPINIRole HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118025903",
      "ndc_label_name": "ROPINIRole HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729023801",
      "ndc_label_name": "rOPINIRole HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547027410",
      "ndc_label_name": "ROPINIRole HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452036220",
      "ndc_label_name": "rOPINIRole HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429082301",
      "ndc_label_name": "rOPINIRole HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332003631",
      "ndc_label_name": "ROPINIRole HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547060110",
      "ndc_label_name": "rOPINIRole HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462025901",
      "ndc_label_name": "ROPINIRole HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668072105",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090577000",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028515",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547059250",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904677961",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668018005",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026245",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781540192",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028517",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090577100",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090577001",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518802",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668018090",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808015603",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722088390",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668018030",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024915",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090743002",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090743001",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090743000",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808015601",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090245102",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033945",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668072190",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024945",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099830",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090743100",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877044090",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024919",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518801",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335058381",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714098901",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547059209",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016999",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011705",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405702",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033915",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268070915",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090245100",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026205",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090748600",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877044005",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011710",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794706",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317701",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016990",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090245101",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026290",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090749201",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026210",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187086430",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000713",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090574501",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687024511",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090574500",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033919",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090749202",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813506",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187086490",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021545",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090577002",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862029499",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090574600",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272300",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919078690",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877503",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813503",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023319",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090748700",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708602",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090663700",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272301",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405703",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367036005",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838402",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023360",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090749300",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708606",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090748601",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090518800",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405706",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000890",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367036009",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090574502",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687024501",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708609",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090749200",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090748602",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788708603",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205005290",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934083430",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407084990",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026290",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000712",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011790",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700083930",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794702",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603036501",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023315",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097830",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788405709",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934027530",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268070911",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687024565",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023317",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934027590",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407015490",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767306",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767302",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000830",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407084910",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767309",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079745",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205005230",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135069190",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813502",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877506",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021560",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862029490",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813509",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288075190",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023345",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788767303",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838403",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934024590",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079715",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794703",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877502",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205082090",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610080145",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788794709",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934024530",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603036502",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205000390",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838406",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205082030",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009001890",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205000399",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788838409",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877509",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367036010",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009001810",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904678061",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668018130",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714099001",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026345",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028615",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668018190",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781540292",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668018105",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024617",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668072205",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567600",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024645",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808015703",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033245",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028617",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668072290",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642201",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642202",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090700400",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090244901",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033217",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547059309",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026390",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026305",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090651901",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090652200",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011805",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090244902",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090244900",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547059350",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353033215",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808015701",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090652201",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090652202",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407085010",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642200",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773001",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272400",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272402",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722088490",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090652401",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090652402",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687025611",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090651902",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700057590",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773000",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090651900",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024615",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090700402",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135069290",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187086530",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090652400",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237017099",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407015590",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011890",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335058481",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090773002",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877044105",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404702",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090700401",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687025601",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070130",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268071011",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272401",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090779300",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026310",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853309",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090700500",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026390",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070190",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877044190",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268071015",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407085090",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853306",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205009930",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011810",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404706",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404709",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853303",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700057530",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700088530",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000813",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079615",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862029599",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009001990",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869802",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869806",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187086590",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237017090",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934024430",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079645",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404703",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862029590",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205009990",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869809",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869803",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853302",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004430",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079653",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367036110",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367036109",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205027930",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367036105",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023417",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004490",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205027990",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603036601",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000812",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205007730",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009001910",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610018745",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205039030",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205039090",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079630",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023445",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079660",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023415",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610092245",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804009090",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205000499",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205000490",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603036602",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603036603",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028710",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668072305",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714099101",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668018230",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668072330",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904678161",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668018205",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781540331",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722088530",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028717",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024545",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028715",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032345",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026405",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035218",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808015801",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024515",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035245",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032318",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547059450",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035219",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026430",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090343700",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808015803",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024518",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035260",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090741300",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335058583",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272501",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026445",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090343701",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353035215",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024560",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090661200",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011990",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862029630",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090741302",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353032360",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090607701",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090607700",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024582",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090673400",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367036230",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877044205",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090748201",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547059403",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090661100",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090741400",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272502",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090673402",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007830",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000911",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268071111",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272500",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090661102",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237017130",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090597002",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090748202",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079360",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335205501",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407085190",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090351500",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090748200",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237017190",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090661101",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011930",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079860",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023216",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187086930",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090351501",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011910",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026430",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090673401",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407085110",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187087230",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804017690",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877044290",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090597000",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862029690",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864902",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407015630",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135069330",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205007830",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008008730",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864909",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090597001",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205017690",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205007890",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862029699",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877044230",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013315",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205017630",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367036209",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090673500",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023218",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007845",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026405",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864903",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205000530",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013345",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007860",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090741301",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603036702",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610021630",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000912",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788864906",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603036703",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079816",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023242",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090748300",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335205502",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189010690",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023245",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000913",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079345",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205000590",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023260",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011905",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079830",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610013330",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079815",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268071115",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603036704",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079845",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009002010",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237017105",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205000599",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919071290",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603036701",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367036205",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205047590",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335205505",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007815",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610023215",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079315",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610079853",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009002030",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904677861",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028415",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729028417",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668017905",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090471002",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714098801",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781540092",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668017930",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668072090",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547059109",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090244700",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668072005",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090546801",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026190",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658026105",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668017990",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722088290",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547059150",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090244701",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808015501",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090630201",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090471000",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317601",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090317600",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335058281",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272200",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090724001",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808015503",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090749002",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135069090",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090749000",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090511000",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011605",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090272201",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090724100",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090630200",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407084810",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836809",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090749001",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090748900",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187086090",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090471001",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407015390",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090724002",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687023411",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842803",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011610",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026190",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862029399",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090511001",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919079930",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026110",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407803",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883906",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50228011690",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731002",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731006",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090511002",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043905",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407806",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883902",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883909",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016890",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731003",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797103",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090630202",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877043990",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367035905",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367035909",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367035910",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788407809",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797109",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797106",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090698900",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000612",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804023430",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009001790",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090724000",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842802",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842806",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000613",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090749100",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002799",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788842809",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205002790",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407084890",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81288075590",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189006530",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237016805",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603036402",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687023401",
      "ndc_label_name": "Rosuvastatin Calcium TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862029390",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788731009",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836803",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836806",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883903",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205035530",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019630",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603036401",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009001710",
      "ndc_label_name": "Rosuvastatin Calcium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722068846",
      "ndc_label_name": "Rufinamide Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452022384",
      "ndc_label_name": "Rufinamide Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651056360",
      "ndc_label_name": "Rufinamide Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180079701",
      "ndc_label_name": "Rufinamide Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877067362",
      "ndc_label_name": "Rufinamide Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054052863",
      "ndc_label_name": "Rufinamide Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603026101",
      "ndc_label_name": "Rufinamide Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205003877",
      "ndc_label_name": "Rufinamide Suspension 40 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378233078",
      "ndc_label_name": "Rufinamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054042523",
      "ndc_label_name": "Rufinamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722059812",
      "ndc_label_name": "Rufinamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571039112",
      "ndc_label_name": "Rufinamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462071308",
      "ndc_label_name": "Rufinamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180080316",
      "ndc_label_name": "Rufinamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651061608",
      "ndc_label_name": "Rufinamide Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651061708",
      "ndc_label_name": "Rufinamide Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054042623",
      "ndc_label_name": "Rufinamide Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378233178",
      "ndc_label_name": "Rufinamide Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180080416",
      "ndc_label_name": "Rufinamide Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571039212",
      "ndc_label_name": "Rufinamide Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722059912",
      "ndc_label_name": "Rufinamide Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462071408",
      "ndc_label_name": "Rufinamide Tablet 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49702025018",
      "ndc_label_name": "Rukobia Tablet Extended Release 12 Hour 600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00169431430",
      "ndc_label_name": "Rybelsus Tablet 14 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00169430399",
      "ndc_label_name": "Rybelsus Tablet 3 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00169430330",
      "ndc_label_name": "Rybelsus Tablet 3 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00169430730",
      "ndc_label_name": "Rybelsus Tablet 7 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "40117033449",
      "ndc_label_name": "Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "40117033451",
      "ndc_label_name": "Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "40117033448",
      "ndc_label_name": "Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "40117033450",
      "ndc_label_name": "Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "40117033452",
      "ndc_label_name": "Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "40117034980",
      "ndc_label_name": "Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "40117033453",
      "ndc_label_name": "Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "40117034981",
      "ndc_label_name": "Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63807010033",
      "ndc_label_name": "Saline Flush ZR Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11917001257",
      "ndc_label_name": "Saline Nasal Spray SOLUTION 0.65 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013329",
      "ndc_label_name": "Saline Nasal Spray SOLUTION 0.65 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917002642",
      "ndc_label_name": "Saline Nasal Spray SOLUTION 0.65 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "32953068965",
      "ndc_label_name": "Saline Nasal Spray Solution 0.65 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00363070530",
      "ndc_label_name": "Saline Nasal Spray SOLUTION 0.65 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295013161",
      "ndc_label_name": "Saline Nasal Spray Solution 0.65 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917003728",
      "ndc_label_name": "Saline Nasal Spray SOLUTION 0.65 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896033345",
      "ndc_label_name": "Saline Nasal Spray Solution 0.65 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295013160",
      "ndc_label_name": "Saline Nasal Spray Solution 0.65 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802035758",
      "ndc_label_name": "Saline Nasal Spray Solution 0.65 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "65504021118",
      "ndc_label_name": "Saline Nasal Spray SOLUTION 0.65 % NASAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896033330",
      "ndc_label_name": "Saline Nasal Spray Solution 0.65 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69618005153",
      "ndc_label_name": "Saline Nasal Spray Solution 0.65 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69618005167",
      "ndc_label_name": "Saline Nasal Spray Solution 0.65 % Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440835090",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835030",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835094",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098230",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629924701",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835060",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293061501",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135049205",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835091",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835040",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135049210",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293061505",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098260",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629244101",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162051250",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293080305",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135049201",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959039440",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192036510",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959039490",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293080301",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162051210",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098211",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367016004",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959039460",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098272",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098255",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664010318",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098290",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629244001",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629924801",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367061501",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098200",
      "ndc_label_name": "Salsalate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835192",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835130",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835140",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835160",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835120",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135049301",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135040401",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42192036610",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135040405",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135040410",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835190",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033224",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835194",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063057730",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135049305",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293061605",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999036760",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033228",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835191",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162051350",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353013770",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293061601",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135049310",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293080405",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51293080401",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033230",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899705",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267019228",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629215001",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664010513",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033260",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629841601",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033240",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899701",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899706",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745701",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899703",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745706",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959033290",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899702",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267019230",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098330",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162051310",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899704",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745709",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162156907",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745703",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267019240",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098311",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367016104",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098300",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098372",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098390",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367061601",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098355",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205098360",
      "ndc_label_name": "Salsalate Tablet 750 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373312800",
      "ndc_label_name": "Sami the Seal Filters",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00078079061",
      "ndc_label_name": "SandoSTATIN LAR Depot Kit 10 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078081181",
      "ndc_label_name": "SandoSTATIN LAR Depot Kit 10 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078081881",
      "ndc_label_name": "SandoSTATIN LAR Depot Kit 20 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078079761",
      "ndc_label_name": "SandoSTATIN LAR Depot Kit 20 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078082581",
      "ndc_label_name": "SandoSTATIN LAR Depot Kit 30 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078080461",
      "ndc_label_name": "SandoSTATIN LAR Depot Kit 30 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078018101",
      "ndc_label_name": "SandoSTATIN SOLUTION 100 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00078018161",
      "ndc_label_name": "SandoSTATIN SOLUTION 100 MCG/ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50484001090",
      "ndc_label_name": "Santyl OINTMENT 250 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50484001030",
      "ndc_label_name": "Santyl OINTMENT 250 UNIT/GM EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722004730",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884094852",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722004701",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598047711",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817085001",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817085030",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884094872",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598047730",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603019330",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603019301",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722004830",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817085130",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884087372",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603019401",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722004801",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603019430",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817085101",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884087352",
      "ndc_label_name": "Sapropterin Dihydrochloride Packet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378470593",
      "ndc_label_name": "sAXagliptin HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862082530",
      "ndc_label_name": "sAXagliptin HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862082590",
      "ndc_label_name": "sAXagliptin HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462072690",
      "ndc_label_name": "sAXagliptin HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462072630",
      "ndc_label_name": "sAXagliptin HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378470577",
      "ndc_label_name": "sAXagliptin HCl Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862082630",
      "ndc_label_name": "sAXagliptin HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462072790",
      "ndc_label_name": "sAXagliptin HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378470693",
      "ndc_label_name": "sAXagliptin HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462072730",
      "ndc_label_name": "sAXagliptin HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378470677",
      "ndc_label_name": "sAXagliptin HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862082690",
      "ndc_label_name": "sAXagliptin HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "15127080413",
      "ndc_label_name": "SB Fib Lax Orange Powder 33 % Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "15127080419",
      "ndc_label_name": "SB Fib Lax Orange Powder 33 % Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "15127020603",
      "ndc_label_name": "SB Lice Treatment Liquid 0.3-3 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "15127020608",
      "ndc_label_name": "SB Lice Treatment Liquid 0.3-3 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50742050504",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858015014",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378647044",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378647099",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591225879",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378647097",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858015040",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629845001",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629845101",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858015070",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802058046",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238166202",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802058062",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591225804",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090534900",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710184602",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710184607",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802058084",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090718800",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335271801",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629845201",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591225823",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238166209",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742050510",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335301301",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238166204",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245302",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742050524",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245304",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710184604",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335301401",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335301501",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162245307",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162141904",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162141902",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162141907",
      "ndc_label_name": "Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13925011601",
      "ndc_label_name": "Se-Natal 19 Tablet 29-1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006537303",
      "ndc_label_name": "Segluromet TABLET 2.5-1000 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006537307",
      "ndc_label_name": "Segluromet Tablet 2.5-1000 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006537306",
      "ndc_label_name": "Segluromet TABLET 2.5-1000 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090621800",
      "ndc_label_name": "Segluromet Tablet 2.5-1000 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090621700",
      "ndc_label_name": "Segluromet Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006536903",
      "ndc_label_name": "Segluromet TABLET 2.5-500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006536907",
      "ndc_label_name": "Segluromet Tablet 2.5-500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006536906",
      "ndc_label_name": "Segluromet TABLET 2.5-500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090623100",
      "ndc_label_name": "Segluromet Tablet 7.5-1000 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006537407",
      "ndc_label_name": "Segluromet Tablet 7.5-1000 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006537406",
      "ndc_label_name": "Segluromet TABLET 7.5-1000 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006537403",
      "ndc_label_name": "Segluromet TABLET 7.5-1000 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006537006",
      "ndc_label_name": "Segluromet TABLET 7.5-500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006537007",
      "ndc_label_name": "Segluromet Tablet 7.5-500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006537003",
      "ndc_label_name": "Segluromet TABLET 7.5-500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135073760",
      "ndc_label_name": "Selegiline HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505005501",
      "ndc_label_name": "Selegiline HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088800",
      "ndc_label_name": "Selegiline HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088890",
      "ndc_label_name": "Selegiline HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088860",
      "ndc_label_name": "Selegiline HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571065906",
      "ndc_label_name": "Selegiline HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954050410",
      "ndc_label_name": "Selegiline HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505005502",
      "ndc_label_name": "Selegiline HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088811",
      "ndc_label_name": "Selegiline HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954050420",
      "ndc_label_name": "Selegiline HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088830",
      "ndc_label_name": "Selegiline HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205088855",
      "ndc_label_name": "Selegiline HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72319000602",
      "ndc_label_name": "Selegiline HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090291800",
      "ndc_label_name": "Selegiline HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429017660",
      "ndc_label_name": "Selegiline HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505343808",
      "ndc_label_name": "Selegiline HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73141000602",
      "ndc_label_name": "Selegiline HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135069460",
      "ndc_label_name": "Selegiline HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505343803",
      "ndc_label_name": "Selegiline HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999074704",
      "ndc_label_name": "Selenium Sulfide Lotion 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432052804",
      "ndc_label_name": "Selenium Sulfide Lotion 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432052805",
      "ndc_label_name": "Selenium Sulfide Lotion 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802004064",
      "ndc_label_name": "Selenium Sulfide Lotion 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090024200",
      "ndc_label_name": "Selenium Sulfide Lotion 2.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49702026055",
      "ndc_label_name": "Selzentry Solution 20 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49702023308",
      "ndc_label_name": "Selzentry Tablet 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49702023508",
      "ndc_label_name": "Selzentry Tablet 75 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49502019580",
      "ndc_label_name": "Semglee Solution 100 UNIT/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919020560",
      "ndc_label_name": "Senna Lax Tablet 8.6 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268073124",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121496705",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "48433021940",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904752894",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17856046201",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121496740",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17856112701",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17856112702",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58657051808",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904752841",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59390012541",
      "ndc_label_name": "Senna SYRUP 8.8 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17856823703",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17856112709",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17856046203",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328002008",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17856112703",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896046208",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17856112704",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60687085140",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328012005",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68094004959",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033012050",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328022015",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328022050",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "72162167202",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17856823701",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629926801",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "39328012050",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54859080808",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17856823702",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033012005",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "48433021905",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57237031005",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "48433021105",
      "ndc_label_name": "Senna SYRUP 8.8 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66424056208",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "82568002408",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70166063605",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57237030124",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "84415002101",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896047208",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57237031054",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60687085177",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68094004962",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69618006958",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71399823708",
      "ndc_label_name": "Senna Syrup 8.8 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67618012012",
      "ndc_label_name": "Senokot Extra Strength TABLET 17.2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "67618012006",
      "ndc_label_name": "Senokot Extra Strength Tablet 17.2 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135069461",
      "ndc_label_name": "Sertraline HCl Concentrate 20 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714060102",
      "ndc_label_name": "Sertraline HCl Concentrate 20 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762006701",
      "ndc_label_name": "Sertraline HCl Concentrate 20 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629877401",
      "ndc_label_name": "Sertraline HCl Concentrate 20 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71093014311",
      "ndc_label_name": "Sertraline HCl Concentrate 20 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980040906",
      "ndc_label_name": "Sertraline HCl Concentrate 20 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714061301",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904692661",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729021715",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063075430",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440831730",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714061305",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714061304",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440831790",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155075903",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155075909",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014790",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063075460",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729021716",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714061306",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722021490",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353041553",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353041530",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014730",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353041515",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353041560",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014705",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155075905",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353041545",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090099100",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353044730",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353044715",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080930",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090691700",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063075490",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080953",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353044745",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208001",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353044753",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090184702",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090099102",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769301",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353041573",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769400",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080945",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770100",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353044773",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208000",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769300",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002121506",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353041580",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770000",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080960",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700036200",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080915",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208002",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268077011",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111017505",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090184700",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700091090",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090184701",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008620",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080973",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090729500",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268082511",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700091030",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320301",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629328901",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320302",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919041630",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080980",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087660",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436630501",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008630",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090321700",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180099204",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770002",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187079530",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090099101",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762516003",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002121500",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071070260",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769302",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645052354",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087630",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629328902",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320300",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008660",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002121503",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788683506",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268077015",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788683508",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700036290",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001305",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770001",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187021230",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629328904",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821006",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762516001",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083502",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687025311",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001330",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268082515",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071070228",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180035309",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821009",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762516002",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083512",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760009190",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180035306",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111017530",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180035305",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788821003",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020505",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687025301",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013101",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187079590",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788683503",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700036230",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788683501",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866901",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934001930",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180099201",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004760",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071131800",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934001990",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760073890",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866902",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010645",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335051001",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645058954",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335051002",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180099202",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013103",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919008690",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866908",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076945",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043560",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866903",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010680",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180099203",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004730",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629328903",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065115",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088680",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065153",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866906",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065130",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020503",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004790",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001301",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076960",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162241105",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076953",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788866909",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065160",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020510",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010673",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001390",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162241101",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789009260",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088645",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020509",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076980",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021003",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043315",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180035302",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789008860",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789009290",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865020705",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010630",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162240703",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010660",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076973",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788683509",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789009230",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031003",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021405",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065145",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865020718",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043580",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012230",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013105",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021418",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012290",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021490",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065173",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031001",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865020730",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021430",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205045530",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009005005",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865020790",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076930",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031002",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205045590",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088660",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335021001",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088673",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010615",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162241100",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010653",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021401",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043545",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021460",
      "ndc_label_name": "Sertraline HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043553",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043573",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610065180",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076915",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088615",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189012260",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789027301",
      "ndc_label_name": "Sertraline HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714061101",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440831590",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904692461",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440831581",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729021510",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440831530",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440831585",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014590",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714061106",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155075709",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729021516",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014530",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090661300",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714061104",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014505",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090739501",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090394700",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090661301",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155075703",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090297600",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090739600",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714061105",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769800",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090761500",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090661400",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090739500",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155075705",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584800",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769900",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729021515",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268076811",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769801",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090761400",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090761401",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353097030",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090723000",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002150703",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090394701",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268082311",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436630601",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268076815",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001190",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090297601",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268082315",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001105",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087260",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087230",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097790",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002150700",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404503",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584801",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187047890",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180035109",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700056290",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002150706",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187047830",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111017330",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788643701",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404501",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001101",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097803",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762634701",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700056230",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180035103",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687023111",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083312",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792803",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788643709",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792801",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001130",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687023101",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645052154",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404506",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020310",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032803",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020303",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012903",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180035106",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097801",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788643703",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404509",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335107802",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335265904",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020305",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012905",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020309",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180097802",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788643706",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868903",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335258701",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335265905",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093012901",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335080803",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032802",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792806",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868901",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868906",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335265907",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865020505",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865020518",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789034690",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335080801",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788792809",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205034330",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335265906",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865020590",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021205",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021260",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865020530",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021230",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868909",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205034390",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021290",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032801",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083302",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335107801",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021201",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335265901",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083305",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335265903",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335107803",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335265902",
      "ndc_label_name": "Sertraline HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021218",
      "ndc_label_name": "Sertraline HCl TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440831685",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714061206",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440831690",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440831630",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904692561",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729021616",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634090471",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714061201",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063003330",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063003360",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729021615",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440831681",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714061205",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155075809",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155075803",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714061204",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085560",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353043845",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155075805",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014630",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014605",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063003390",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090686100",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722021390",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207101",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090637902",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098901",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085590",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722014690",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081715",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090766100",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063085530",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090394501",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090766101",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207100",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353043815",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353060315",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081760",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51655083052",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081745",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002119203",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090783000",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090637900",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353060345",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081730",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098902",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087560",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090098900",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111017405",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268082411",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769102",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207102",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769200",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090637901",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002119200",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268076911",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700034030",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436352001",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436630401",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090308902",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760073790",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090766200",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002119206",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268076915",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700094830",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087590",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087530",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090394500",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629330903",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769100",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700094890",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111017430",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118021309",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762644302",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760061290",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090394502",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788642901",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090769101",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760098890",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762644301",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687024201",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762644303",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760073730",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090766102",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861203",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268082415",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919045760",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687024211",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919034530",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760068390",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629330901",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700022530",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861206",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919034560",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919045790",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919001460",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071054856",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919045730",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629330904",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180098603",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873203",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919034590",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071054828",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187076760",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071131700",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001205",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001230",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083412",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873206",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187005530",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180098604",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629330902",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180035206",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001290",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071054860",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013001",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873209",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187076730",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788810901",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629330905",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180035209",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788642906",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180035202",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002830",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097083402",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180098601",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861201",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862001201",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788810903",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788642909",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180035205",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162237008",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081860",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788642903",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013005",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180098602",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788810909",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788873201",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020409",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055130",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865020605",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788810906",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335230001",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645052254",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934018830",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934018890",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335040303",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021318",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021305",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020403",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335230004",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788642902",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205002890",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093013003",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162237003",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021360",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021330",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020405",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335295501",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788642908",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205020560",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205020590",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055190",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021390",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020002",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010020410",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335295502",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861209",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335230003",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335230002",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001360",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335040302",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162237009",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934016990",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162237001",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001330",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865020690",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335230005",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001390",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865020618",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020003",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205020530",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865020630",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282021301",
      "ndc_label_name": "Sertraline HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009004905",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335971401",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335040301",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081845",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335040304",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162237006",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081815",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081830",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020001",
      "ndc_label_name": "Sertraline HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "38779239201",
      "ndc_label_name": "Sesame Oil OIL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927510900",
      "ndc_label_name": "Sesame Oil Oil",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779239209",
      "ndc_label_name": "Sesame Oil OIL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452651003",
      "ndc_label_name": "Sesame Oil OIL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991135303",
      "ndc_label_name": "Sesame Oil OIL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779239205",
      "ndc_label_name": "Sesame Oil OIL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552044205",
      "ndc_label_name": "Sesame Oil OIL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452651002",
      "ndc_label_name": "Sesame Oil OIL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "38779239207",
      "ndc_label_name": "Sesame Oil OIL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991135302",
      "ndc_label_name": "Sesame Oil OIL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49452651001",
      "ndc_label_name": "Sesame Oil OIL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51927143600",
      "ndc_label_name": "Sesame Oil OIL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779239208",
      "ndc_label_name": "Sesame Oil OIL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552044207",
      "ndc_label_name": "Sesame Oil OIL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62991135301",
      "ndc_label_name": "Sesame Oil OIL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268072011",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904670782",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24979018646",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00955105027",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342021558",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11788011607",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571073927",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904670706",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687032831",
      "ndc_label_name": "Sevelamer Carbonate TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162005827",
      "ndc_label_name": "Sevelamer Carbonate TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380087267",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714081401",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268072015",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111078927",
      "ndc_label_name": "Sevelamer Carbonate TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407070627",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111078911",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862092127",
      "ndc_label_name": "Sevelamer Carbonate TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094003464",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111078948",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687032833",
      "ndc_label_name": "Sevelamer Carbonate TABLET 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69680014395",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335302101",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687032865",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687032811",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205096667",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382082427",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162249902",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367042327",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76282040727",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097096793",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162249904",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335302102",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335302103",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162249909",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162249901",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73190001427",
      "ndc_label_name": "Sevelamer Carbonate Tablet 800 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60258015101",
      "ndc_label_name": "SF Gel 1.1 % Dental",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090514700",
      "ndc_label_name": "Shingrix Suspension Reconstituted 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090337200",
      "ndc_label_name": "Shingrix Suspension Reconstituted 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160082311",
      "ndc_label_name": "Shingrix Suspension Reconstituted 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160081912",
      "ndc_label_name": "Shingrix Suspension Reconstituted 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08373252100",
      "ndc_label_name": "Sidestream Adult Face Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373616000",
      "ndc_label_name": "Sidestream Adult Face Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373025531",
      "ndc_label_name": "Sidestream Adult Face Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373438200",
      "ndc_label_name": "Sidestream Pediatric Face Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373552900",
      "ndc_label_name": "Sidestream Pediatric Face Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373043461",
      "ndc_label_name": "Sidestream Pediatric Face Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08373346100",
      "ndc_label_name": "Sidestream Pediatric Face Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373052521",
      "ndc_label_name": "Sidestream Pls Adult Face Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "13668018590",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668018505",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722077690",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378165777",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342053610",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093551798",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904667106",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241012403",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090308201",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687041611",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063055010",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904667104",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098210",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241012405",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063067630",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034510",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700067730",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687078811",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063098230",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722077605",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261801",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342012110",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034553",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353034520",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135037290",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187061910",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261800",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090176600",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090308200",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291093790",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090176601",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090285801",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078950",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797403",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090390500",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090523601",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817029500",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063066830",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090523600",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268071715",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629502902",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797406",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268071711",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762003301",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817029590",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063067610",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187061990",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187061920",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071207201",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205030530",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078920",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687078821",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700067750",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090390501",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629502905",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078910",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071207202",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205062330",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078990",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082620",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762003303",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700067790",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788737904",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078930",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071207208",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189029815",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629502906",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082690",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687041621",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082640",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205050990",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629502907",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788768006",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888001890",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788768003",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081330",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082650",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862068890",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028804",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862068899",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205062390",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030404",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788768004",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187081350",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187061930",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001036305",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028806",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205062310",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189029890",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804024330",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797404",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629502901",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162035111",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001059705",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335164904",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335100502",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804024390",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008003850",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335164902",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629502903",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028802",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071207203",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189029830",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030402",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189029820",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071207204",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888001800",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629502904",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030403",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788768009",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030401",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804018590",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009009490",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788797409",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739007233",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162236309",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162035109",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788737903",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788737906",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788737909",
      "ndc_label_name": "Sildenafil Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335028801",
      "ndc_label_name": "Sildenafil Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462426003",
      "ndc_label_name": "Silicone Mask/Adult",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462426013",
      "ndc_label_name": "Silicone Mask/Adult",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462426011",
      "ndc_label_name": "Silicone Mask/Infant",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462426001",
      "ndc_label_name": "Silicone Mask/Infant",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462426002",
      "ndc_label_name": "Silicone Mask/Pediatric",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462426012",
      "ndc_label_name": "Silicone Mask/Pediatric",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090071700",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440012405",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959063500",
      "ndc_label_name": "Silver sulfADIAZINE Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436124001",
      "ndc_label_name": "Silver sulfADIAZINE Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440012425",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440012420",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959063525",
      "ndc_label_name": "Silver sulfADIAZINE Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090076300",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090215200",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440012440",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762013102",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002090969",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440012450",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090060700",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959063585",
      "ndc_label_name": "Silver sulfADIAZINE Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002090987",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436309901",
      "ndc_label_name": "Silver sulfADIAZINE Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762013105",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762013104",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118991002",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440012485",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959063550",
      "ndc_label_name": "Silver sulfADIAZINE Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118991004",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919020625",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762013100",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762013106",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187002350",
      "ndc_label_name": "Silver sulfADIAZINE Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629877101",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118991005",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877012450",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629876801",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877012405",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760096250",
      "ndc_label_name": "Silver sulfADIAZINE Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59762013108",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629877001",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877012485",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187002325",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788060005",
      "ndc_label_name": "Silver sulfADIAZINE Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877012420",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629876901",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919020650",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877012440",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877012425",
      "ndc_label_name": "Silver Sulfadiazine CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629877201",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187002351",
      "ndc_label_name": "Silver sulfADIAZINE Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629877301",
      "ndc_label_name": "Silver Sulfadiazine Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788060002",
      "ndc_label_name": "Silver sulfADIAZINE Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425022101",
      "ndc_label_name": "Silver sulfADIAZINE Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43292056408",
      "ndc_label_name": "Simethicone Extra Strength CAPSULE 125 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135020324",
      "ndc_label_name": "Simethicone TABLET CHEWABLE 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440835315",
      "ndc_label_name": "Simethicone Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135020313",
      "ndc_label_name": "Simethicone TABLET CHEWABLE 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135020364",
      "ndc_label_name": "Simethicone TABLET CHEWABLE 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864086001",
      "ndc_label_name": "Simethicone Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440835320",
      "ndc_label_name": "Simethicone Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00440835302",
      "ndc_label_name": "Simethicone Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333081210",
      "ndc_label_name": "Simethicone Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135020360",
      "ndc_label_name": "Simethicone TABLET CHEWABLE 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090219403",
      "ndc_label_name": "Simethicone Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63739022502",
      "ndc_label_name": "Simethicone Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610060704",
      "ndc_label_name": "Simethicone Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54738051801",
      "ndc_label_name": "Simethicone TABLET CHEWABLE 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904720660",
      "ndc_label_name": "Simethicone Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69618003301",
      "ndc_label_name": "Simethicone TABLET CHEWABLE 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "82804004330",
      "ndc_label_name": "Simethicone Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610065004",
      "ndc_label_name": "Simethicone Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610064904",
      "ndc_label_name": "Simethicone Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135020390",
      "ndc_label_name": "Simethicone TABLET CHEWABLE 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333081225",
      "ndc_label_name": "Simethicone Tablet Chewable 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536130608",
      "ndc_label_name": "Simethicone Ultra Strength Capsule 180 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68788878506",
      "ndc_label_name": "Simethicone Ultra Strength Capsule 180 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68788878503",
      "ndc_label_name": "Simethicone Ultra Strength Capsule 180 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090608800",
      "ndc_label_name": "Simethicone Ultra Strength Capsule 180 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536142108",
      "ndc_label_name": "Simethicone Ultra Strength Capsule 180 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "24658050190",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050110",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090692100",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440832130",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135050905",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135050930",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063072790",
      "ndc_label_name": "Simvastatin TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440832190",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063016230",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090127700",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343002245",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135050990",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000410",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714068203",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090127701",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000415",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458093416",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959098830",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629339201",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714068201",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722051110",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090692101",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343002230",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000417",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005130",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118047803",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382006605",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714068202",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090623600",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090692200",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002152700",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050130",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071071630",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005199",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836901",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571001090",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090623601",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343002290",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002152703",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050145",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382006616",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084051101",
      "ndc_label_name": "Simvastatin TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836906",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304079090",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343002299",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382006610",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111019890",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722051190",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000212",
      "ndc_label_name": "Simvastatin TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180047803",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037409",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000214",
      "ndc_label_name": "Simvastatin TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005126",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836903",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919068830",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063072730",
      "ndc_label_name": "Simvastatin TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079830",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037410",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000215",
      "ndc_label_name": "Simvastatin TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025060",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084051111",
      "ndc_label_name": "Simvastatin TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032030",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005190",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111019805",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007630",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205079890",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267126001",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096660",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096630",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025030",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180047801",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111019830",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677001590",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096653",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180047802",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919068890",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677001510",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629119701",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007645",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739057110",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189045290",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071171109",
      "ndc_label_name": "Simvastatin TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788836909",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025045",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061545",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610096645",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189045230",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009001310",
      "ndc_label_name": "Simvastatin Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714068303",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135051090",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722051210",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050210",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440832230",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000510",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135051030",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050290",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000515",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714068301",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022930",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050245",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440832290",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022915",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571002010",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063000890",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086188",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714068302",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086130",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722051290",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135051005",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077315",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571002090",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022960",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090099903",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050230",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086160",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063000830",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000517",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077360",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022945",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090630602",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343002345",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999088960",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090630601",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090099901",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077345",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086145",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086109",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638901",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343002399",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090501900",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343002390",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090099902",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086115",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090480101",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090480102",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090639000",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959098930",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739057210",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629119801",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436012202",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090630603",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638903",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090480103",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002152803",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111019910",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005290",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180047901",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919044690",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090630700",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343002330",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090638902",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760000590",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111019990",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084051211",
      "ndc_label_name": "Simvastatin TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000314",
      "ndc_label_name": "Simvastatin TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071069930",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002152800",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919044630",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111019930",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005230",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760000530",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180047902",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205080990",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382006710",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458093316",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005299",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267126101",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037509",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760058530",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834203",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062230",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382006716",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111019905",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084051201",
      "ndc_label_name": "Simvastatin TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934037730",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000312",
      "ndc_label_name": "Simvastatin TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005226",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834206",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062260",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005260",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919044660",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834209",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677001690",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610060945",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180047903",
      "ndc_label_name": "Simvastatin TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788986903",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042190",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062215",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382006705",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000315",
      "ndc_label_name": "Simvastatin TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645047054",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031690",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788834201",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005215",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037510",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677001610",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005245",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042130",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062245",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677001645",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789031630",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009001410",
      "ndc_label_name": "Simvastatin Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090100004",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440832330",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353085615",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440832390",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714068401",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050345",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135051130",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050310",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642003",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135051105",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353085688",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050390",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571004090",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722051390",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714068403",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050330",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343002445",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135051190",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090100001",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722051310",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353000745",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353000760",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000610",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063072690",
      "ndc_label_name": "Simvastatin TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002156900",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714068402",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642004",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353085645",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54458093216",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642404",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000615",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022715",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002156903",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729000617",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642100",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090100003",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043130",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760057930",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063072630",
      "ndc_label_name": "Simvastatin TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022745",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043190",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571004010",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642403",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642401",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046409",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187044930",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077445",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077415",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005390",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353085617",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642500",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343002499",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382006810",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005399",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353077460",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353085630",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005030",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999090315",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959094430",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020010",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837901",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382006816",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353085660",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090100002",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005060",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090473601",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020005",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005322",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934049330",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837903",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090473603",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090473602",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062360",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090473604",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020030",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046403",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030430",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837906",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642002",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343002490",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042730",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090490100",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111020090",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180046406",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789030490",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788837909",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021011",
      "ndc_label_name": "Simvastatin TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687021001",
      "ndc_label_name": "Simvastatin TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042790",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642001",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760000630",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382006805",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677001710",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062330",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788986803",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739057310",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005330",
      "ndc_label_name": "Simvastatin TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090642402",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000414",
      "ndc_label_name": "Simvastatin TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68645052754",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019290",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062345",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934049390",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037609",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677001745",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343002430",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019230",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000412",
      "ndc_label_name": "Simvastatin TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009001510",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760057990",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007745",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187044990",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007730",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629119901",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610061045",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367037610",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007760",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000415",
      "ndc_label_name": "Simvastatin TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062315",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610005045",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007715",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677001790",
      "ndc_label_name": "Simvastatin Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714068101",
      "ndc_label_name": "Simvastatin TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781507031",
      "ndc_label_name": "Simvastatin TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440832090",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135050890",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729015610",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440832030",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050090",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781507092",
      "ndc_label_name": "Simvastatin TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629119601",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714068102",
      "ndc_label_name": "Simvastatin TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135050805",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090254300",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729015615",
      "ndc_label_name": "Simvastatin TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135050830",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090138700",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729015617",
      "ndc_label_name": "Simvastatin TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050010",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722051010",
      "ndc_label_name": "Simvastatin TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343002190",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343002199",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722051090",
      "ndc_label_name": "Simvastatin TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658050030",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919071090",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111019790",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42571000590",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090777600",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005090",
      "ndc_label_name": "Simvastatin TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000112",
      "ndc_label_name": "Simvastatin TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999090090",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090645900",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739057010",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205007090",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343002130",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000114",
      "ndc_label_name": "Simvastatin TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377000115",
      "ndc_label_name": "Simvastatin TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009001290",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111019705",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111019730",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677001490",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009001210",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382006516",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304078990",
      "ndc_label_name": "Simvastatin TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84677001410",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862005030",
      "ndc_label_name": "Simvastatin TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382006510",
      "ndc_label_name": "Simvastatin Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50419042201",
      "ndc_label_name": "Skyla INTRAUTERINE DEVICE 13.5 MG INTRAUTERINE",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70000024401",
      "ndc_label_name": "Sleep Aid (DiphenhydrAMINE) Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "36800044164",
      "ndc_label_name": "Sleep Aid TABLET 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113044164",
      "ndc_label_name": "Sleep Aid TABLET 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056434",
      "ndc_label_name": "Sleep Aid Tablet 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113044173",
      "ndc_label_name": "Sleep Aid TABLET 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917004068",
      "ndc_label_name": "Sleep Aid Tablet 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00067434730",
      "ndc_label_name": "Slow Fe Tablet Extended Release 142 (45 Fe) MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00067434730",
      "ndc_label_name": "Slow Fe Tablet Extended Release 45 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00067434772",
      "ndc_label_name": "Slow Fe Tablet Extended Release 45 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86790001930",
      "ndc_label_name": "Slow Fe Tablet Extended Release 45 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00067434760",
      "ndc_label_name": "Slow Fe Tablet Extended Release 45 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00067434790",
      "ndc_label_name": "Slow Fe Tablet Extended Release 45 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "86790001960",
      "ndc_label_name": "Slow Fe Tablet Extended Release 45 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845014315",
      "ndc_label_name": "Slow Release Iron Tablet Extended Release 160 (50 Fe) MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917008581",
      "ndc_label_name": "Slow Release Iron Tablet Extended Release 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "40985027343",
      "ndc_label_name": "Slow Release Iron Tablet Extended Release 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917017062",
      "ndc_label_name": "Slow Release Iron Tablet Extended Release 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917019900",
      "ndc_label_name": "Slow Release Iron Tablet Extended Release 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81131007178",
      "ndc_label_name": "Slow Release Iron Tablet Extended Release 45 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845015265",
      "ndc_label_name": "Slow Release Iron Tablet Extended Release 50 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10939062844",
      "ndc_label_name": "SM One Daily Prenatal 28-0.8 & 440 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00121059500",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121059515",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237031952",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00121119030",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121119000",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135086851",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135043447",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237031931",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62135086943",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121059516",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237031903",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "62135086924",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135086824",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57237031915",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "84447001701",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58657031016",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367032016",
      "ndc_label_name": "Sod Citrate-Citric Acid Solution 500-334 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00223172002",
      "ndc_label_name": "Sodium Bicarbonate TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00223172001",
      "ndc_label_name": "Sodium Bicarbonate TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536104610",
      "ndc_label_name": "Sodium Bicarbonate TABLET 325 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45861008010",
      "ndc_label_name": "Sodium Bicarbonate Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70369000201",
      "ndc_label_name": "Sodium Bicarbonate Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135068410",
      "ndc_label_name": "Sodium Bicarbonate Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54738003503",
      "ndc_label_name": "Sodium Bicarbonate Tablet 325 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353004153",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904726161",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135068510",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353004160",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00223172101",
      "ndc_label_name": "Sodium Bicarbonate TABLET 650 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00223172102",
      "ndc_label_name": "Sodium Bicarbonate TABLET 650 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353004180",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "24689013701",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353038185",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353016260",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353004185",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353016253",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536104710",
      "ndc_label_name": "Sodium Bicarbonate TABLET 650 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353016280",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353016270",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353016285",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610043894",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353016294",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45861008110",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353038160",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353038170",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "64980029410",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353038153",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090302100",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333082710",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69367025810",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "64980052810",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353038194",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353038180",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66553000801",
      "ndc_label_name": "Sodium Bicarbonate TABLET 650 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610043860",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629877501",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333082725",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610066953",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610043853",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54738002003",
      "ndc_label_name": "Sodium Bicarbonate TABLET 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610044553",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69618003410",
      "ndc_label_name": "Sodium Bicarbonate TABLET 650 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610066960",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610043870",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70369000101",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610044560",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610043880",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610044580",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71610066980",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333083110",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333083125",
      "ndc_label_name": "Sodium Bicarbonate Tablet 650 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17478062235",
      "ndc_label_name": "Sodium Chloride (Hypertonic) Ointment 5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536125391",
      "ndc_label_name": "Sodium Chloride (Hypertonic) Ointment 5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00363905000",
      "ndc_label_name": "Sodium Chloride (Hypertonic) OINTMENT 5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17238062035",
      "ndc_label_name": "Sodium Chloride (Hypertonic) OINTMENT 5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71406012335",
      "ndc_label_name": "Sodium Chloride (Hypertonic) Ointment 5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917021417",
      "ndc_label_name": "Sodium Chloride (Hypertonic) Solution 5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015134",
      "ndc_label_name": "Sodium Chloride (Hypertonic) SOLUTION 5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17238062515",
      "ndc_label_name": "Sodium Chloride (Hypertonic) SOLUTION 5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536125494",
      "ndc_label_name": "Sodium Chloride (Hypertonic) Solution 5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69618007755",
      "ndc_label_name": "Sodium Chloride (Hypertonic) Solution 5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "17478062312",
      "ndc_label_name": "Sodium Chloride (Hypertonic) Solution 5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68883060005",
      "ndc_label_name": "Sodium Chloride Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00019118827",
      "ndc_label_name": "Sodium Chloride Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "08881579121",
      "ndc_label_name": "Sodium Chloride Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68883060010",
      "ndc_label_name": "Sodium Chloride Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68883070010",
      "ndc_label_name": "Sodium Chloride Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73177016903",
      "ndc_label_name": "Sodium Chloride Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73177016905",
      "ndc_label_name": "Sodium Chloride Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68883060016",
      "ndc_label_name": "Sodium Chloride Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487930133",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 0.9 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135083284",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 0.9 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378698789",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 0.9 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204030003",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 0.9 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487930103",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 0.9 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756066199",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 0.9 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090292900",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 0.9 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378698501",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 0.9 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204030005",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 0.9 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378698601",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 0.9 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487930201",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 0.9 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204030050",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 0.9 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378699789",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 3 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487900360",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 3 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756066360",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 3 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487900330",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 3 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204002260",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 3 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487900730",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 7 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487900760",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 7 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76204002160",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 7 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50190014123",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 7 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83490030760",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 7 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756066460",
      "ndc_label_name": "Sodium Chloride Nebulization Solution 7 % Inhalation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264780001",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264580210",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264180036",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264180031",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004931",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264780000",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264780010",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338055318",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004904",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264780020",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004911",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264180032",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338966040",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264780009",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338055311",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338915130",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004910",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004948",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338915930",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264580200",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338966235",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004903",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338980401",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338979101",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954302",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338966160",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954304",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004902",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338979301",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004941",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271070105",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338980440",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954305",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338980824",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338965775",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004918",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338979312",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954303",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271070106",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338980801",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409710102",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487430105",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338979140",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338004938",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062375",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338954306",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084151",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990798309",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409710169",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990798437",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409710168",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338958396",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219022201",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409710104",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76297000122",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271070102",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487430125",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219022450",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487430150",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409710166",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219022401",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487430110",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76297000131",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271070107",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990798302",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219046605",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990798361",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409710167",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219046805",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990798303",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76297000141",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062361",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990798423",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73177016927",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990798420",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990798355",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084106",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062353",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "79672061310",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062374",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990798436",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "79672061305",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219046660",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990798413",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084110",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219022225",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047410",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219022001",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271070103",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "79672061340",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084160",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323062376",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084150",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219046850",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "79672061303",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047205",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219021801",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084125",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "79672061304",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047030",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73177016925",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "79672061330",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219021850",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047220",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73177016928",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084105",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219022010",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047405",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "79672061301",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084111",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219047005",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73177016926",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "79672061302",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084126",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76297000101",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76297000102",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76297000112",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512084161",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76297000132",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76297000111",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "79672061320",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76297000142",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "79672061350",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76297000121",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264220100",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338004727",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00264220170",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338004729",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00264220110",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338004744",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338011001",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00264738850",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338004746",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338004747",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338005144",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00990797207",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00264220150",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338005047",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00990713809",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00264738860",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338004802",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00990797205",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338011004",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338004804",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57896000225",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00990797208",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65219050603",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338004805",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00338004803",
      "ndc_label_name": "Sodium Chloride SOLUTION 0.9 % IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00990613803",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00990613822",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57896000210",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00990713836",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65219050630",
      "ndc_label_name": "Sodium Chloride Solution 0.9 % Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237036101",
      "ndc_label_name": "Sodium Chloride Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135078301",
      "ndc_label_name": "Sodium Chloride Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69367022001",
      "ndc_label_name": "Sodium Chloride Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "83335000201",
      "ndc_label_name": "Sodium Chloride Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333083525",
      "ndc_label_name": "Sodium Chloride Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00223176001",
      "ndc_label_name": "Sodium Chloride TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00223176002",
      "ndc_label_name": "Sodium Chloride TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333084410",
      "ndc_label_name": "Sodium Chloride Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58657011801",
      "ndc_label_name": "Sodium Chloride Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536134201",
      "ndc_label_name": "Sodium Chloride Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70795112001",
      "ndc_label_name": "Sodium Chloride TABLET 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904723961",
      "ndc_label_name": "Sodium Chloride Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "81033002801",
      "ndc_label_name": "Sodium Chloride Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58657011901",
      "ndc_label_name": "Sodium Chloride Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333083510",
      "ndc_label_name": "Sodium Chloride Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70795112000",
      "ndc_label_name": "Sodium Chloride TABLET 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333084425",
      "ndc_label_name": "Sodium Chloride Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629115101",
      "ndc_label_name": "Sodium Fluoride 5000 Plus Cream 1.1 % Dental",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69367030951",
      "ndc_label_name": "Sodium Fluoride 5000 Plus Cream 1.1 % Dental",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61269016550",
      "ndc_label_name": "Sodium Fluoride Solution 1.1 (0.5 F) MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657032250",
      "ndc_label_name": "Sodium Fluoride Solution 1.1 (0.5 F) MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629113001",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 0.55 (0.25 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59088010473",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 0.55 (0.25 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58223067504",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 0.55 (0.25 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162165202",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 0.55 (0.25 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657016012",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 0.55 (0.25 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826016320",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 0.55 (0.25 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162165300",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 1.1 (0.5 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58223067404",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 1.1 (0.5 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657016112",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 1.1 (0.5 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629113201",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 1.1 (0.5 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657016110",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 1.1 (0.5 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59088010573",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 1.1 (0.5 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162165302",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 1.1 (0.5 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629113101",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 1.1 (0.5 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826016420",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 1.1 (0.5 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629113301",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 2.2 (1 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58223067604",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 2.2 (1 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59088010673",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 2.2 (1 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58223067304",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 2.2 (1 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58223067701",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 2.2 (1 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657016212",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 2.2 (1 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75826016520",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 2.2 (1 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58223067601",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 2.2 (1 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335272401",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 2.2 (1 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162165402",
      "ndc_label_name": "Sodium Fluoride Tablet Chewable 2.2 (1 F) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054962857",
      "ndc_label_name": "Sodium Oxybate Solution 500 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238239101",
      "ndc_label_name": "Sodium Oxybate Solution 500 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162006587",
      "ndc_label_name": "Sodium Oxybate Solution 500 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722089118",
      "ndc_label_name": "Sodium Oxybate Solution 500 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42794008614",
      "ndc_label_name": "Sodium Phenylbutyrate POWDER 3 GM/TSP ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884000604",
      "ndc_label_name": "Sodium Phenylbutyrate POWDER 3 GM/TSP Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884017004",
      "ndc_label_name": "Sodium Phenylbutyrate TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462085320",
      "ndc_label_name": "Sodium Phenylbutyrate Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50488500101",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46287001216",
      "ndc_label_name": "Sodium Polystyrene Sulfonate POWDER ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135014614",
      "ndc_label_name": "Sodium Polystyrene Sulfonate POWDER ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702003645",
      "ndc_label_name": "Sodium Polystyrene Sulfonate POWDER ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135014617",
      "ndc_label_name": "Sodium Polystyrene Sulfonate POWDER ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135034011",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51293083197",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11534016615",
      "ndc_label_name": "Sodium Polystyrene Sulfonate POWDER ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629203101",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135034062",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629884901",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135034053",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10702003615",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629239001",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335285501",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11534016616",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162123007",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70166071210",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "11534016644",
      "ndc_label_name": "Sodium Polystyrene Sulfonate POWDER ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629885001",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24658076016",
      "ndc_label_name": "Sodium Polystyrene Sulfonate POWDER Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162123002",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806001394",
      "ndc_label_name": "Sodium Polystyrene Sulfonate Powder Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42806001396",
      "ndc_label_name": "Sodium Polystyrene Sulfonate POWDER ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72626270101",
      "ndc_label_name": "Sofosbuvir-Velpatasvir Tablet 400-100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00009082501",
      "ndc_label_name": "Solu-CORTEF Solution Reconstituted 100 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009001103",
      "ndc_label_name": "Solu-CORTEF Solution Reconstituted 100 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009001104",
      "ndc_label_name": "Solu-CORTEF Solution Reconstituted 100 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154394205",
      "ndc_label_name": "Solu-CORTEF Solution Reconstituted 100 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009069801",
      "ndc_label_name": "Solu-MEDROL SOLUTION RECONSTITUTED 1000 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009069802",
      "ndc_label_name": "Solu-MEDROL Solution Reconstituted 1000 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569155500",
      "ndc_label_name": "SOLU-medrol Solution Reconstituted 125 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54569393400",
      "ndc_label_name": "SOLU-medrol Solution Reconstituted 40 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00009075801",
      "ndc_label_name": "SOLU-Medrol Solution Reconstituted 500 MG Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16042001144",
      "ndc_label_name": "SootheNeb NBL 100 Adult Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001145",
      "ndc_label_name": "SootheNeb NBL 100 Child Mask",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001147",
      "ndc_label_name": "SootheNeb NBL 100 Med Cup",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16042001146",
      "ndc_label_name": "SootheNeb NBL 100 Mesh Cap",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00480542589",
      "ndc_label_name": "SORAfenib Tosylate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668068212",
      "ndc_label_name": "SORAfenib Tosylate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979071544",
      "ndc_label_name": "SORAfenib Tosylate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598045804",
      "ndc_label_name": "SORAfenib Tosylate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407076012",
      "ndc_label_name": "SORAfenib Tosylate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378120178",
      "ndc_label_name": "SORAfenib Tosylate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806012201",
      "ndc_label_name": "Sotalol HCl (AF) TABLET 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385012601",
      "ndc_label_name": "Sotalol HCl (AF) Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135071601",
      "ndc_label_name": "Sotalol HCl (AF) Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505022301",
      "ndc_label_name": "Sotalol HCl (AF) TABLET 120 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651077601",
      "ndc_label_name": "Sotalol HCl (AF) Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505022401",
      "ndc_label_name": "Sotalol HCl (AF) TABLET 160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385012701",
      "ndc_label_name": "Sotalol HCl (AF) Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806012301",
      "ndc_label_name": "Sotalol HCl (AF) TABLET 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135071701",
      "ndc_label_name": "Sotalol HCl (AF) Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651077701",
      "ndc_label_name": "Sotalol HCl (AF) Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806012101",
      "ndc_label_name": "Sotalol HCl (AF) TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007430",
      "ndc_label_name": "Sotalol HCl (AF) Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651077501",
      "ndc_label_name": "Sotalol HCl (AF) Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135071501",
      "ndc_label_name": "Sotalol HCl (AF) Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610007460",
      "ndc_label_name": "Sotalol HCl (AF) Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505022201",
      "ndc_label_name": "Sotalol HCl (AF) TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385012501",
      "ndc_label_name": "Sotalol HCl (AF) Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429074901",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440836191",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440836130",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440836190",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093106001",
      "ndc_label_name": "Sotalol HCl TABLET 120 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629242301",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268072515",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095160",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162211601",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268072511",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440836160",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788005201",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505015900",
      "ndc_label_name": "Sotalol HCl TABLET 120 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584084210",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162258401",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095172",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095130",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095100",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135066201",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584084230",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013801",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162193201",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095155",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385011501",
      "ndc_label_name": "Sotalol HCl TABLET 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095190",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095111",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804095196",
      "ndc_label_name": "Sotalol HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135066301",
      "ndc_label_name": "Sotalol HCl Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429075001",
      "ndc_label_name": "Sotalol HCl Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093106201",
      "ndc_label_name": "Sotalol HCl TABLET 160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505008100",
      "ndc_label_name": "Sotalol HCl TABLET 160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788005301",
      "ndc_label_name": "Sotalol HCl Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440836230",
      "ndc_label_name": "Sotalol HCl Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440836260",
      "ndc_label_name": "Sotalol HCl Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162193301",
      "ndc_label_name": "Sotalol HCl Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629242101",
      "ndc_label_name": "Sotalol HCl Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440836290",
      "ndc_label_name": "Sotalol HCl Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162211701",
      "ndc_label_name": "Sotalol HCl Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162258501",
      "ndc_label_name": "Sotalol HCl Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584084310",
      "ndc_label_name": "Sotalol HCl Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440836291",
      "ndc_label_name": "Sotalol HCl Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013501",
      "ndc_label_name": "Sotalol HCl Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385011601",
      "ndc_label_name": "Sotalol HCl TABLET 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788005401",
      "ndc_label_name": "Sotalol HCl Tablet 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505008200",
      "ndc_label_name": "Sotalol HCl TABLET 240 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429075101",
      "ndc_label_name": "Sotalol HCl Tablet 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093106301",
      "ndc_label_name": "Sotalol HCl TABLET 240 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584084410",
      "ndc_label_name": "Sotalol HCl Tablet 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013601",
      "ndc_label_name": "Sotalol HCl Tablet 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162258601",
      "ndc_label_name": "Sotalol HCl Tablet 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084065401",
      "ndc_label_name": "Sotalol HCl TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268072415",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440836091",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610029430",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440836090",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093106101",
      "ndc_label_name": "Sotalol HCl TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440836060",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440836030",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610088980",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904714361",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429074801",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610029460",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "11788005101",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135066101",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061630",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090129900",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162211801",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090129902",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584084110",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789013701",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061660",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090779600",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080430",
      "ndc_label_name": "Sotalol HCl TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084980",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097472",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090779602",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69584084150",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097460",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629242201",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268072411",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084065411",
      "ndc_label_name": "Sotalol HCl TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162193101",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097490",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505008000",
      "ndc_label_name": "Sotalol HCl TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047480",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162258301",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335282301",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004630",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047460",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76385011401",
      "ndc_label_name": "Sotalol HCl TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072360",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610029480",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072330",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097400",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610038580",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097455",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072380",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097411",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804097430",
      "ndc_label_name": "Sotalol HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958150101",
      "ndc_label_name": "Sovaldi TABLET 400 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80777010204",
      "ndc_label_name": "Spikevax Suspension 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80777010295",
      "ndc_label_name": "Spikevax Suspension 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80777010201",
      "ndc_label_name": "Spikevax Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80777010293",
      "ndc_label_name": "Spikevax Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80777010296",
      "ndc_label_name": "Spikevax Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "28595057004",
      "ndc_label_name": "Spinosad Suspension 0.9 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52246057004",
      "ndc_label_name": "Spinosad Suspension 0.9 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "84635057004",
      "ndc_label_name": "Spinosad Suspension 0.9 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489014410",
      "ndc_label_name": "Spironolactone-HCTZ TABLET 25-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440839060",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629107103",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292001701",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629106801",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440839030",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378040305",
      "ndc_label_name": "Spironolactone-HCTZ TABLET 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378040301",
      "ndc_label_name": "Spironolactone-HCTZ TABLET 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335267403",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42292001720",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762501401",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489014405",
      "ndc_label_name": "Spironolactone-HCTZ TABLET 25-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162162501",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440839091",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335220201",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629107101",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162162504",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489014401",
      "ndc_label_name": "Spironolactone-HCTZ TABLET 25-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335267402",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629106901",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162162503",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335267401",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162162506",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629107102",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162162505",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993018802",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162162500",
      "ndc_label_name": "Spironolactone-HCTZ Tablet 25-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00003085222",
      "ndc_label_name": "Sprycel Tablet 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00003085722",
      "ndc_label_name": "Sprycel Tablet 140 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00003052711",
      "ndc_label_name": "Sprycel Tablet 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00003052811",
      "ndc_label_name": "Sprycel Tablet 50 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00003052411",
      "ndc_label_name": "Sprycel Tablet 70 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00003085522",
      "ndc_label_name": "Sprycel Tablet 80 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "46287000660",
      "ndc_label_name": "SPS (Sodium Polystyrene Sulf) Suspension 15 GM/60ML Combination",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154735302",
      "ndc_label_name": "SPS (Sodium Polystyrene Sulf) Suspension 15 GM/60ML Combination",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46287000601",
      "ndc_label_name": "SPS (Sodium Polystyrene Sulf) Suspension 15 GM/60ML Combination",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46287000604",
      "ndc_label_name": "SPS (Sodium Polystyrene Sulf) Suspension 30 GM/120ML Rectal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "46287000601",
      "ndc_label_name": "SPS Suspension 15 GM/60ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722051560",
      "ndc_label_name": "Stavudine Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722051660",
      "ndc_label_name": "Stavudine Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722051760",
      "ndc_label_name": "Stavudine Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722051860",
      "ndc_label_name": "Stavudine Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006536407",
      "ndc_label_name": "Steglatro Tablet 15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006536406",
      "ndc_label_name": "Steglatro TABLET 15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006536403",
      "ndc_label_name": "Steglatro TABLET 15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090618300",
      "ndc_label_name": "Steglatro Tablet 15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006536303",
      "ndc_label_name": "Steglatro TABLET 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090618200",
      "ndc_label_name": "Steglatro Tablet 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006536307",
      "ndc_label_name": "Steglatro Tablet 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006536306",
      "ndc_label_name": "Steglatro TABLET 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264785020",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641614701",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338001329",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338001308",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264785010",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264738560",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409488724",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264738550",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338001306",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789013205",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338978201",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517301025",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409488717",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264785000",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517301001",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338001304",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641614710",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81483003100",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409488750",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789013207",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409488720",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409002410",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517302001",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409002401",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789013105",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409799009",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00487610501",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090287401",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409488725",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990711807",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55154012705",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409488710",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323018509",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "14789013107",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00641614725",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323018504",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409488799",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135083384",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420008210",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409488723",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323018550",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323017876",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990799009",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323018507",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17271075007",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00409711807",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323018505",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323018510",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253002091",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00517302025",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323018508",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323018520",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323018500",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63323017826",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219018701",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572074710",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64253002030",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219018710",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72572074701",
      "ndc_label_name": "Sterile Water for Injection Solution Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264738650",
      "ndc_label_name": "Sterile Water for Irrigation SOLUTION IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338000347",
      "ndc_label_name": "Sterile Water for Irrigation SOLUTION IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264210110",
      "ndc_label_name": "Sterile Water for Irrigation SOLUTION IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264210100",
      "ndc_label_name": "Sterile Water for Irrigation SOLUTION IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990613922",
      "ndc_label_name": "Sterile Water for Irrigation Solution Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338000344",
      "ndc_label_name": "Sterile Water for Irrigation SOLUTION IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264210150",
      "ndc_label_name": "Sterile Water for Irrigation Solution Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264210170",
      "ndc_label_name": "Sterile Water for Irrigation Solution Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00264738660",
      "ndc_label_name": "Sterile Water for Irrigation SOLUTION IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338000403",
      "ndc_label_name": "Sterile Water for Irrigation SOLUTION IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338000404",
      "ndc_label_name": "Sterile Water for Irrigation SOLUTION IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338000402",
      "ndc_label_name": "Sterile Water for Irrigation SOLUTION IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338000346",
      "ndc_label_name": "Sterile Water for Irrigation SOLUTION IRRIGATION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990713909",
      "ndc_label_name": "Sterile Water for Irrigation Solution Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990613903",
      "ndc_label_name": "Sterile Water for Irrigation Solution Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00338000405",
      "ndc_label_name": "Sterile Water for Irrigation Solution Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50421000878",
      "ndc_label_name": "Sterile Water for Irrigation Solution Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00990713936",
      "ndc_label_name": "Sterile Water for Irrigation Solution Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50421000877",
      "ndc_label_name": "Sterile Water for Irrigation Solution Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219049903",
      "ndc_label_name": "Sterile Water for Irrigation Solution Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65219049930",
      "ndc_label_name": "Sterile Water for Irrigation Solution Irrigation",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70000059401",
      "ndc_label_name": "Stomach Relief Tablet 262 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090237502",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363000920",
      "ndc_label_name": "Stool Softener CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363410040",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69618008601",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00113048672",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00363000905",
      "ndc_label_name": "Stool Softener CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66424039901",
      "ndc_label_name": "Stool Softener CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090237501",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090237504",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50436122201",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335073803",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162225501",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917002603",
      "ndc_label_name": "Stool Softener CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54257090206",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50436039901",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896040101",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896040125",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896040120",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788774403",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66424039910",
      "ndc_label_name": "Stool Softener CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71335073801",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000009103",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000009101",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788774401",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "65504004695",
      "ndc_label_name": "Stool Softener CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788774406",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "70000009102",
      "ndc_label_name": "Stool Softener Capsule 100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917016475",
      "ndc_label_name": "Stop Lice Aerosol 0.5 %",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00363017324",
      "ndc_label_name": "Stop Lice Complete Treatment Kit 0.33-4-0.5 % Combination",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49022037696",
      "ndc_label_name": "Stop Lice Complete Treatment KIT 0.33-4-0.5 % COMBINATION",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61958120101",
      "ndc_label_name": "Stribild TABLET 150-150-200-300 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00597019261",
      "ndc_label_name": "Striverdi Respimat Aerosol Solution 2.5 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121074700",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121074740",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121074750",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121097440",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121097400",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121097450",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121074730",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00254101196",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121097494",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904747072",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904747018",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904726918",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904726966",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074511",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54738000542",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00713079175",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378920535",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073808",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904747095",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073856",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742038642",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739019372",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689030516",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904747056",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904747001",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739019351",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268073211",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094004361",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339014819",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094004162",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689079099",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291078142",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668075442",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162006205",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687073823",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094004362",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033014944",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339014817",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162247902",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268073212",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074514",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339020917",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380014901",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69339020919",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094004359",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817084016",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033014952",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82182010614",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689079040",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66689079050",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094004159",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094004161",
      "ndc_label_name": "Sucralfate Suspension 1 GM/10ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093221001",
      "ndc_label_name": "Sucralfate TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093221005",
      "ndc_label_name": "Sucralfate TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079075320",
      "ndc_label_name": "Sucralfate TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291093690",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006194",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033000301",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006160",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033000305",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440839512",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093221098",
      "ndc_label_name": "Sucralfate TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687069511",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090528700",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999091400",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291075750",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687069501",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090645500",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440839560",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006170",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788894603",
      "ndc_label_name": "Sucralfate TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219165601",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407088190",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090058200",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877901",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079075301",
      "ndc_label_name": "Sucralfate TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629915301",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629915201",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054194",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739094310",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762040105",
      "ndc_label_name": "Sucralfate TABLET 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934052560",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054160",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154437900",
      "ndc_label_name": "Sucralfate TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024470",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018801",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189023490",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831603",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135043601",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001760",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054170",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762040101",
      "ndc_label_name": "Sucralfate TABLET 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135043690",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425037701",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804006330",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162226401",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788831601",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024494",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009101",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788894601",
      "ndc_label_name": "Sucralfate TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877903",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162226405",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425021301",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042990",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238165601",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189023420",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001770",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001794",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024460",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578008101",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578008105",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189042920",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804010230",
      "ndc_label_name": "Sucralfate Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50580053604",
      "ndc_label_name": "Sudafed Childrens Liquid 15 MG/5ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00045053704",
      "ndc_label_name": "Sudafed PE Childrens SOLUTION 2.5 MG/5ML ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "45802089626",
      "ndc_label_name": "Sulfacetamide Sodium (Acne) LOTION 10 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682001004",
      "ndc_label_name": "Sulfacetamide Sodium (Acne) LOTION 10 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090024600",
      "ndc_label_name": "Sulfacetamide Sodium Solution 10 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959011701",
      "ndc_label_name": "Sulfacetamide Sodium Solution 10 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090221600",
      "ndc_label_name": "Sulfacetamide Sodium Solution 10 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118990901",
      "ndc_label_name": "Sulfacetamide Sodium Solution 10 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002090173",
      "ndc_label_name": "Sulfacetamide Sodium Solution 10 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208067004",
      "ndc_label_name": "Sulfacetamide Sodium Solution 10 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314070101",
      "ndc_label_name": "Sulfacetamide Sodium Solution 10 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919020915",
      "ndc_label_name": "Sulfacetamide Sodium Solution 10 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999014410",
      "ndc_label_name": "Sulfacetamide Sodium Solution 10 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788987101",
      "ndc_label_name": "Sulfacetamide Sodium Solution 10 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60758001805",
      "ndc_label_name": "Sulfacetamide Sodium Solution 10 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208031705",
      "ndc_label_name": "Sulfacetamide-Prednisolone Solution 10-0.23 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959056703",
      "ndc_label_name": "Sulfacetamide-prednisoLONE Solution 10-0.23 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999052405",
      "ndc_label_name": "Sulfacetamide-prednisoLONE Solution 10-0.23 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788860704",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121085340",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090052500",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383082420",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121085320",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383082316",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383082416",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856049603",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856049602",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527518070",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959076603",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959076607",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118990804",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim SUSPENSION 200-40 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383082421",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559055016",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856049601",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954025810",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959076605",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090458400",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021988",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim SUSPENSION 200-40 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135074947",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862049647",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim SUSPENSION 200-40 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629196901",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66993072757",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 200-40 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687044275",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 800-160 MG/20ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033001240",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 800-160 MG/20ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033001220",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 800-160 MG/20ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687044224",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 800-160 MG/20ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135087324",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 800-160 MG/20ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135087352",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Suspension 800-160 MG/20ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489014501",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 400-80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489014505",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 400-80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440840528",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 400-80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268072811",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 400-80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060365",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 400-80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746027101",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 400-80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291075801",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 400-80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237023205",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 400-80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162027110",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 400-80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162027150",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 400-80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440840540",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 400-80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862041901",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 400-80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291075850",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 400-80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862041905",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 400-80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268072815",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 400-80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746027105",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 400-80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237023201",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 400-80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687060311",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 400-80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429025801",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 400-80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135089790",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 400-80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135089718",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 400-80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835810",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090219900",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291075901",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440240620",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835840",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835806",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835803",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835804",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835820",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090287302",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090154200",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835802",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090219800",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904272561",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291075950",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090154300",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291075912",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090484700",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220100",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440835881",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090219803",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090154100",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220001",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090219805",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090484701",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090484703",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090484702",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090154500",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090247902",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090219801",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021010",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090219901",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567907",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090484705",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090484707",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090219802",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090289000",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090219807",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021030",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220000",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090690107",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567901",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567902",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567900",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090485000",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090485001",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489014601",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090289001",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090690400",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090568002",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567905",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090567903",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090568200",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090568201",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700061128",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090484802",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090700800",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090690202",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014400",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746027201",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090690100",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014406",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061411",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090690101",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090739301",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090690401",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014410",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700061114",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014414",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014421",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760054106",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090690102",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014428",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090739900",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014415",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429025905",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021000",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021028",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760054114",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014420",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014460",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021056",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021060",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760006906",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021040",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700061120",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014406",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014430",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021006",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237023305",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021080",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064510",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348062506",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760006914",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919021020",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959014440",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489014605",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760054120",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746027205",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629176502",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348062514",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760006920",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064520",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021014",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700061106",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014456",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54348062520",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629176506",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118042008",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919076614",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000820",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002021020",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237023301",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919021028",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064514",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267019628",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760006910",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629176501",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187069510",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014414",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429025901",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064528",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000810",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081014",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014420",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629176507",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187069520",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187069514",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061401",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064560",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000840",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000303",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919014430",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934054414",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267019606",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862042005",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064556",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187069528",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187069506",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267019614",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064502",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789006406",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267019610",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267019620",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267019660",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187069540",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162027210",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788712204",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919076610",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000101",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788712201",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762206",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267081602",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187078206",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762201",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081028",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919076620",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000201",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004906",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335076201",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267081604",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862042001",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004910",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001802",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135089818",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267019630",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934054406",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001814",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788712206",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788712202",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004920",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788712203",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135089890",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788712208",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934054420",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762202",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788712207",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762207",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934054410",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762208",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000814",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004914",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081006",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335076202",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762203",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335076205",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081010",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000302",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000828",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001806",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788762204",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789006420",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629176508",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001828",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004312",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006414",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629176510",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006430",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081020",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006428",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162027250",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000301",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081040",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425000304",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934004306",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim TABLET 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335076204",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934054428",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001840",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001804",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001860",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001810",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006420",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789001820",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789006414",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006406",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420006410",
      "ndc_label_name": "Sulfamethoxazole-Trimethoprim Tablet 800-160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762010405",
      "ndc_label_name": "SulfaSALAzine Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762010406",
      "ndc_label_name": "SulfaSALAzine Tablet Delayed Release 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440843060",
      "ndc_label_name": "Sulindac Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591566101",
      "ndc_label_name": "Sulindac TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904621640",
      "ndc_label_name": "Sulindac Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440843020",
      "ndc_label_name": "Sulindac Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591566105",
      "ndc_label_name": "Sulindac TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440843030",
      "ndc_label_name": "Sulindac Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019660",
      "ndc_label_name": "Sulindac Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019600",
      "ndc_label_name": "Sulindac Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489047805",
      "ndc_label_name": "Sulindac TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019610",
      "ndc_label_name": "Sulindac Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019614",
      "ndc_label_name": "Sulindac Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806001801",
      "ndc_label_name": "Sulindac TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904733460",
      "ndc_label_name": "Sulindac Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658077005",
      "ndc_label_name": "Sulindac TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267026420",
      "ndc_label_name": "Sulindac TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789037301",
      "ndc_label_name": "Sulindac Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806001805",
      "ndc_label_name": "Sulindac TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019615",
      "ndc_label_name": "Sulindac Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489047801",
      "ndc_label_name": "Sulindac TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019630",
      "ndc_label_name": "Sulindac Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789037382",
      "ndc_label_name": "Sulindac Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019620",
      "ndc_label_name": "Sulindac Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440843192",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591566001",
      "ndc_label_name": "Sulindac TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658077105",
      "ndc_label_name": "Sulindac TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904621740",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440843160",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440843130",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806001101",
      "ndc_label_name": "Sulindac TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019515",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019518",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019514",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090052901",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267019740",
      "ndc_label_name": "Sulindac TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591566005",
      "ndc_label_name": "Sulindac TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806001105",
      "ndc_label_name": "Sulindac TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090209304",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019530",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267019715",
      "ndc_label_name": "Sulindac TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289093030",
      "ndc_label_name": "Sulindac TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090052904",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289093010",
      "ndc_label_name": "Sulindac TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904733560",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999065630",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019528",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289093020",
      "ndc_label_name": "Sulindac TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267019720",
      "ndc_label_name": "Sulindac TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019520",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489047901",
      "ndc_label_name": "Sulindac TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789037401",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090052804",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959019560",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074430",
      "ndc_label_name": "Sulindac TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919021130",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53489047905",
      "ndc_label_name": "Sulindac TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629320802",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629320801",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267019730",
      "ndc_label_name": "Sulindac TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700068260",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789037482",
      "ndc_label_name": "Sulindac Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043022200",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407001309",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043022209",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090113000",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030009",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090291600",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714079801",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378563259",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111029309",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980066227",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980066291",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436014801",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756052288",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111029398",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959051009",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253500",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700089909",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756052269",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205027409",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002156209",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700091809",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980066236",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111029390",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111029336",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853509",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788677809",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425022401",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304009919",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187093109",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452034660",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425025801",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629445201",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452034672",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862014836",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267126309",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040409",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420050009",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043022009",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111029190",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714079601",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111029136",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090214400",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090593900",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043022000",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378563059",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700075909",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090743600",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407001109",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756052069",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436462201",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756052088",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980066091",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304009719",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919095009",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980066027",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111029109",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980066036",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788676909",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189059609",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420049909",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862014636",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452034460",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267126509",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111029198",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788820509",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189043209",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452034472",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090112900",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378563159",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700009330",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436462301",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700096909",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356043930",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043022100",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356043936",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407001209",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714079701",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118999109",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111029290",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756052169",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111029209",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043022109",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436014701",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919040809",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002159209",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980066127",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700093609",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031802",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111029298",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111029236",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756052188",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304009819",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788861909",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980066191",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187079709",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862014736",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980066136",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452034560",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420049809",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189043309",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788954709",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267126409",
      "ndc_label_name": "SUMAtriptan Succinate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518004101",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804016909",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452034572",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425031801",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047501",
      "ndc_label_name": "SUMAtriptan Succinate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304009127",
      "ndc_label_name": "SUNItinib Malate Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651046428",
      "ndc_label_name": "SUNItinib Malate Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714067601",
      "ndc_label_name": "SUNItinib Malate Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093819928",
      "ndc_label_name": "SUNItinib Malate Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598004563",
      "ndc_label_name": "SUNItinib Malate Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82293001410",
      "ndc_label_name": "SUNItinib Malate Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378667828",
      "ndc_label_name": "SUNItinib Malate Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291090128",
      "ndc_label_name": "SUNItinib Malate Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205011628",
      "ndc_label_name": "SUNItinib Malate Capsule 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093822428",
      "ndc_label_name": "SUNItinib Malate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291090228",
      "ndc_label_name": "SUNItinib Malate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378667928",
      "ndc_label_name": "SUNItinib Malate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205011728",
      "ndc_label_name": "SUNItinib Malate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304009227",
      "ndc_label_name": "SUNItinib Malate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598004663",
      "ndc_label_name": "SUNItinib Malate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82293001510",
      "ndc_label_name": "SUNItinib Malate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714067701",
      "ndc_label_name": "SUNItinib Malate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651046528",
      "ndc_label_name": "SUNItinib Malate Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291090328",
      "ndc_label_name": "SUNItinib Malate Capsule 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093822928",
      "ndc_label_name": "SUNItinib Malate Capsule 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598004763",
      "ndc_label_name": "SUNItinib Malate Capsule 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304009327",
      "ndc_label_name": "SUNItinib Malate Capsule 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714067801",
      "ndc_label_name": "SUNItinib Malate Capsule 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378668128",
      "ndc_label_name": "SUNItinib Malate Capsule 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651046628",
      "ndc_label_name": "SUNItinib Malate Capsule 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205011828",
      "ndc_label_name": "SUNItinib Malate Capsule 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82293001610",
      "ndc_label_name": "SUNItinib Malate Capsule 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651046728",
      "ndc_label_name": "SUNItinib Malate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093823128",
      "ndc_label_name": "SUNItinib Malate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714067901",
      "ndc_label_name": "SUNItinib Malate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291090428",
      "ndc_label_name": "SUNItinib Malate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378668028",
      "ndc_label_name": "SUNItinib Malate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205011928",
      "ndc_label_name": "SUNItinib Malate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304009427",
      "ndc_label_name": "SUNItinib Malate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82293001710",
      "ndc_label_name": "SUNItinib Malate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598004863",
      "ndc_label_name": "SUNItinib Malate Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356011506",
      "ndc_label_name": "Sustiva Tablet 600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00056051030",
      "ndc_label_name": "Sustiva Tablet 600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356011530",
      "ndc_label_name": "Sustiva Tablet 600 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63807010301",
      "ndc_label_name": "SwabFlush Saline Flush Solution 0.9 % Intravenous",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51167066101",
      "ndc_label_name": "Symdeko Tablet Therapy Pack 100-150 & 150 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51167011301",
      "ndc_label_name": "Symdeko Tablet Therapy Pack 50-75 & 75 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "78670013102",
      "ndc_label_name": "Symjepi Solution Prefilled Syringe 0.15 MG/0.3ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "78670013111",
      "ndc_label_name": "Symjepi Solution Prefilled Syringe 0.15 MG/0.3ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59676080030",
      "ndc_label_name": "Symtuza Tablet 800-150-200-10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60574411301",
      "ndc_label_name": "Synagis Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66658023101",
      "ndc_label_name": "Synagis Solution 100 MG/ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66658023001",
      "ndc_label_name": "Synagis Solution 50 MG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60574411401",
      "ndc_label_name": "Synagis Solution 50 MG/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00025016608",
      "ndc_label_name": "Synarel SOLUTION 2 MG/ML NASAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00065019093",
      "ndc_label_name": "Systane Contacts SOLUTION OPHTHALMIC",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "59746079801",
      "ndc_label_name": "Tacrolimus Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904662361",
      "ndc_label_name": "Tacrolimus CAPSULE 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079081720",
      "ndc_label_name": "Tacrolimus CAPSULE 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079081701",
      "ndc_label_name": "Tacrolimus CAPSULE 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084044911",
      "ndc_label_name": "Tacrolimus CAPSULE 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111052501",
      "ndc_label_name": "Tacrolimus CAPSULE 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175038037",
      "ndc_label_name": "Tacrolimus CAPSULE 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378204501",
      "ndc_label_name": "Tacrolimus CAPSULE 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009016401",
      "ndc_label_name": "Tacrolimus Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429037701",
      "ndc_label_name": "Tacrolimus CAPSULE 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462068501",
      "ndc_label_name": "Tacrolimus Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380072006",
      "ndc_label_name": "Tacrolimus Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70748021901",
      "ndc_label_name": "Tacrolimus Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629872501",
      "ndc_label_name": "Tacrolimus Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781210201",
      "ndc_label_name": "Tacrolimus CAPSULE 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877027801",
      "ndc_label_name": "Tacrolimus Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72572076001",
      "ndc_label_name": "Tacrolimus Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82983040010",
      "ndc_label_name": "Tacrolimus Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714009801",
      "ndc_label_name": "Tacrolimus Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004101",
      "ndc_label_name": "Tacrolimus CAPSULE 0.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084044901",
      "ndc_label_name": "Tacrolimus CAPSULE 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377001411",
      "ndc_label_name": "Tacrolimus Capsule 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429037801",
      "ndc_label_name": "Tacrolimus CAPSULE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291075301",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904709761",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781210301",
      "ndc_label_name": "Tacrolimus CAPSULE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714009901",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031753",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031709",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378204601",
      "ndc_label_name": "Tacrolimus CAPSULE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804003230",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031780",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031770",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079081820",
      "ndc_label_name": "Tacrolimus CAPSULE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031716",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090224500",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877027901",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729004201",
      "ndc_label_name": "Tacrolimus CAPSULE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82983040110",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090558100",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079081801",
      "ndc_label_name": "Tacrolimus CAPSULE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "54288013501",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111052601",
      "ndc_label_name": "Tacrolimus CAPSULE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009005401",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629872301",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090559600",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62175038137",
      "ndc_label_name": "Tacrolimus CAPSULE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746079901",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084045011",
      "ndc_label_name": "Tacrolimus CAPSULE 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70377001511",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380072106",
      "ndc_label_name": "Tacrolimus CAPSULE 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084045001",
      "ndc_label_name": "Tacrolimus CAPSULE 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70748022001",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462068601",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72572076101",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452015420",
      "ndc_label_name": "Tacrolimus Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079002801",
      "ndc_label_name": "Tacrolimus CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378204701",
      "ndc_label_name": "Tacrolimus CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781210401",
      "ndc_label_name": "Tacrolimus CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904662461",
      "ndc_label_name": "Tacrolimus CAPSULE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291075401",
      "ndc_label_name": "Tacrolimus Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714010001",
      "ndc_label_name": "Tacrolimus Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629872601",
      "ndc_label_name": "Tacrolimus Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729004301",
      "ndc_label_name": "Tacrolimus CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429037901",
      "ndc_label_name": "Tacrolimus CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82983040210",
      "ndc_label_name": "Tacrolimus Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380072206",
      "ndc_label_name": "Tacrolimus Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111052701",
      "ndc_label_name": "Tacrolimus CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59746080001",
      "ndc_label_name": "Tacrolimus Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51079002820",
      "ndc_label_name": "Tacrolimus CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377001611",
      "ndc_label_name": "Tacrolimus Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62175038237",
      "ndc_label_name": "Tacrolimus CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877028001",
      "ndc_label_name": "Tacrolimus Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462068701",
      "ndc_label_name": "Tacrolimus Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748022101",
      "ndc_label_name": "Tacrolimus Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084045101",
      "ndc_label_name": "Tacrolimus CAPSULE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084045111",
      "ndc_label_name": "Tacrolimus CAPSULE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82009016501",
      "ndc_label_name": "Tacrolimus Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093342892",
      "ndc_label_name": "Tacrolimus Ointment 0.03 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342810",
      "ndc_label_name": "Tacrolimus Ointment 0.03 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729042101",
      "ndc_label_name": "Tacrolimus Ointment 0.03 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802039000",
      "ndc_label_name": "Tacrolimus OINTMENT 0.03 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462088135",
      "ndc_label_name": "Tacrolimus Ointment 0.03 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168041730",
      "ndc_label_name": "Tacrolimus OINTMENT 0.03 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168041760",
      "ndc_label_name": "Tacrolimus OINTMENT 0.03 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802039002",
      "ndc_label_name": "Tacrolimus OINTMENT 0.03 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462088194",
      "ndc_label_name": "Tacrolimus Ointment 0.03 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342830",
      "ndc_label_name": "Tacrolimus Ointment 0.03 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729042110",
      "ndc_label_name": "Tacrolimus Ointment 0.03 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168041799",
      "ndc_label_name": "Tacrolimus OINTMENT 0.03 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729042112",
      "ndc_label_name": "Tacrolimus Ointment 0.03 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462088165",
      "ndc_label_name": "Tacrolimus Ointment 0.03 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802039001",
      "ndc_label_name": "Tacrolimus OINTMENT 0.03 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802070002",
      "ndc_label_name": "Tacrolimus OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168041630",
      "ndc_label_name": "Tacrolimus OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342910",
      "ndc_label_name": "Tacrolimus Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462053435",
      "ndc_label_name": "Tacrolimus Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342992",
      "ndc_label_name": "Tacrolimus Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462053465",
      "ndc_label_name": "Tacrolimus Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922001109",
      "ndc_label_name": "Tacrolimus Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093342930",
      "ndc_label_name": "Tacrolimus Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462053494",
      "ndc_label_name": "Tacrolimus Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168041699",
      "ndc_label_name": "Tacrolimus OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00168041660",
      "ndc_label_name": "Tacrolimus OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729042201",
      "ndc_label_name": "Tacrolimus Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922001105",
      "ndc_label_name": "Tacrolimus Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729042210",
      "ndc_label_name": "Tacrolimus Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68308070301",
      "ndc_label_name": "Tacrolimus Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16729042212",
      "ndc_label_name": "Tacrolimus Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802070000",
      "ndc_label_name": "Tacrolimus OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922001107",
      "ndc_label_name": "Tacrolimus Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802070001",
      "ndc_label_name": "Tacrolimus OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68308070360",
      "ndc_label_name": "Tacrolimus Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310134930",
      "ndc_label_name": "Tagrisso Tablet 40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310124830",
      "ndc_label_name": "Tagrisso Tablet 40 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310125130",
      "ndc_label_name": "Tagrisso Tablet 80 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00310135030",
      "ndc_label_name": "Tagrisso Tablet 80 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440845092",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378014491",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862064260",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407043960",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440845030",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591247218",
      "ndc_label_name": "Tamoxifen Citrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440845060",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739014310",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862064210",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090048501",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739026910",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862044710",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591247260",
      "ndc_label_name": "Tamoxifen Citrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862044760",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090253301",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651029960",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907005810",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162222506",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429090960",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382082614",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162220806",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907005860",
      "ndc_label_name": "Tamoxifen Citrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440845192",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591247319",
      "ndc_label_name": "Tamoxifen Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862044630",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862064330",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090094200",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378027493",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591247330",
      "ndc_label_name": "Tamoxifen Citrate TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440845160",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382082701",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407044030",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651030090",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907005930",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382082706",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440845130",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429091030",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862044610",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162220903",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51862064310",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907005910",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651030030",
      "ndc_label_name": "Tamoxifen Citrate Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228299650",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228299611",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015915",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714071302",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440846060",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440845590",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440846030",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440846091",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440845581",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440846090",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001330",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063072530",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781207601",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440846081",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440846092",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015944",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001353",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904640189",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090184600",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063072590",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714071301",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904640180",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904640161",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063026401",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001953",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904738361",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090184601",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063094790",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291098910",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063026430",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001930",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001360",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353066330",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342015911",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090669900",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001380",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353066360",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001960",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407087990",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353066353",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090364600",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063026490",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074015",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353001980",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353066380",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090364601",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700067030",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090490600",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090670000",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063094730",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237001405",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237001401",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037107",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135077530",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187035890",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919029830",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074001",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090669901",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760045090",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679051604",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037130",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756016013",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778001",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756016081",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760059890",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074011",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135077590",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877045005",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084029901",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756016088",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778002",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877045010",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070330",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700067090",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187035830",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013201",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009230",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187037190",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827701",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705009",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862059805",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187035807",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679051603",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013216",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205021714",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862059801",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827706",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778006",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084029911",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739056710",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877045001",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934009290",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072430",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705001",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205068814",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072453",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705002",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64679051602",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072470",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335071105",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091030",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705006",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091053",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162250200",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705008",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071084930",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083530",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073870",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162250901",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778008",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091060",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162250905",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778003",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084029965",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162221705",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083560",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865028290",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205021730",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162250205",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091080",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778009",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013210",
      "ndc_label_name": "Tamsulosin HCl CAPSULE 0.4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603011501",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083553",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827703",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788705003",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865028205",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610083580",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788827709",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074890",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282074405",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091070",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072460",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072480",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073830",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162250201",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073880",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073853",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603011502",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282074490",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610073860",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009002510",
      "ndc_label_name": "Tamsulosin HCl Capsule 0.4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08317260291",
      "ndc_label_name": "TechLITE Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260292",
      "ndc_label_name": "TechLITE Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260293",
      "ndc_label_name": "TechLITE Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260301",
      "ndc_label_name": "TechLITE Insulin Syringe 30G X 1/2\" 0.3 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260303",
      "ndc_label_name": "TechLITE Insulin Syringe 30G X 1/2\" 0.5 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260305",
      "ndc_label_name": "TechLITE Insulin Syringe 30G X 1/2\" 1 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260302",
      "ndc_label_name": "TechLITE Insulin Syringe 30G X 5/16\" 0.3 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260304",
      "ndc_label_name": "TechLITE Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260314",
      "ndc_label_name": "TechLITE Insulin Syringe 31G X 15/64\" 0.3 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260315",
      "ndc_label_name": "TechLITE Insulin Syringe 31G X 15/64\" 0.5 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260316",
      "ndc_label_name": "TechLITE Insulin Syringe 31G X 15/64\" 1 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260311",
      "ndc_label_name": "TechLITE Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260312",
      "ndc_label_name": "TechLITE Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317260313",
      "ndc_label_name": "TechLITE Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "08317230129",
      "ndc_label_name": "TechLite Pen Needles 29G X 10MM",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317232129",
      "ndc_label_name": "TechLite Pen Needles 29G X 12MM",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317235131",
      "ndc_label_name": "TechLite Pen Needles 31G X 5 MM",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317236131",
      "ndc_label_name": "TechLite Pen Needles 31G X 6 MM",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317238131",
      "ndc_label_name": "TechLite Pen Needles 31G X 8 MM",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317234132",
      "ndc_label_name": "TechLite Pen Needles 32G X 4 MM",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317236132",
      "ndc_label_name": "TechLite Pen Needles 32G X 6 MM",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "08317238132",
      "ndc_label_name": "TechLite Pen Needles 32G X 8 MM",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "35356066460",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228207650",
      "ndc_label_name": "Temazepam CAPSULE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440847514",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268077911",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228207610",
      "ndc_label_name": "Temazepam CAPSULE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440014605",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440014601",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406996101",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031220",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031210",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031215",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407050705",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356066430",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289019690",
      "ndc_label_name": "Temazepam CAPSULE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031230",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053540",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031245",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031253",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031228",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053512",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090018600",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332038071",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547061250",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289019630",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436462802",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547061210",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031260",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118014603",
      "ndc_label_name": "Temazepam CAPSULE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289019682",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629860201",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268077915",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162055650",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053510",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053528",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053560",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429050601",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544013653",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544013660",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877014605",
      "ndc_label_name": "Temazepam CAPSULE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544013610",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053515",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289019614",
      "ndc_label_name": "Temazepam CAPSULE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289019601",
      "ndc_label_name": "Temazepam CAPSULE 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919021430",
      "ndc_label_name": "Temazepam CAPSULE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091400",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716306",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019102",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716303",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959053530",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289019660",
      "ndc_label_name": "Temazepam CAPSULE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162055610",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788813903",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091460",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008653",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544013614",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091430",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746055601",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118014606",
      "ndc_label_name": "Temazepam CAPSULE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544013615",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335974104",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091490",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062528",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544013620",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335031503",
      "ndc_label_name": "Temazepam CAPSULE 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332038031",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919026330",
      "ndc_label_name": "Temazepam CAPSULE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544013645",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008628",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062510",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062545",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877014601",
      "ndc_label_name": "Temazepam CAPSULE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335031506",
      "ndc_label_name": "Temazepam CAPSULE 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187013230",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544013630",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716309",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008630",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062530",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162182405",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091472",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062515",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629860301",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788716301",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335031502",
      "ndc_label_name": "Temazepam CAPSULE 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420047305",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162182401",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019101",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335031505",
      "ndc_label_name": "Temazepam CAPSULE 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788849303",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544013628",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091455",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062520",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335031501",
      "ndc_label_name": "Temazepam CAPSULE 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420047301",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335031504",
      "ndc_label_name": "Temazepam CAPSULE 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420047360",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420047390",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335290001",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420047330",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610008930",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062553",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062560",
      "ndc_label_name": "Temazepam Capsule 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090028501",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440014705",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406996201",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353026030",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356066315",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228207710",
      "ndc_label_name": "Temazepam CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00228207750",
      "ndc_label_name": "Temazepam CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440014701",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045910",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356066330",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268078013",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090235601",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356066360",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440847614",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353026015",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353026028",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289066001",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436462902",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436462901",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045930",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407050805",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353026020",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353026060",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547061410",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162055750",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289066060",
      "ndc_label_name": "Temazepam CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045915",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53746055701",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289066030",
      "ndc_label_name": "Temazepam CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353026053",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999034690",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547061450",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091530",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289066090",
      "ndc_label_name": "Temazepam CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045960",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043830",
      "ndc_label_name": "Temazepam CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332038231",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268078011",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267032130",
      "ndc_label_name": "Temazepam CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045900",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010130",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629860501",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629162101",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698603",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788690401",
      "ndc_label_name": "Temazepam CAPSULE 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045912",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788690403",
      "ndc_label_name": "Temazepam CAPSULE 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289066082",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062653",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629860601",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267032110",
      "ndc_label_name": "Temazepam CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698606",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698609",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959045920",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788690406",
      "ndc_label_name": "Temazepam CAPSULE 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118014703",
      "ndc_label_name": "Temazepam CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162182505",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267032160",
      "ndc_label_name": "Temazepam CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518410600",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788808103",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091500",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162055710",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788690408",
      "ndc_label_name": "Temazepam CAPSULE 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429050701",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420047501",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877014705",
      "ndc_label_name": "Temazepam CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335296501",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091590",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091560",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267032128",
      "ndc_label_name": "Temazepam CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091555",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919026430",
      "ndc_label_name": "Temazepam CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420047560",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698608",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010120",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026260",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010153",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877014701",
      "ndc_label_name": "Temazepam CAPSULE 30 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062615",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332038271",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062628",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205091572",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010160",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062630",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610062660",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335230201",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789044930",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788690409",
      "ndc_label_name": "Temazepam CAPSULE 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098628",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335291001",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026228",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788698601",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420047530",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010115",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420047505",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098660",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610098630",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029501",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010128",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029503",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610010159",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162182501",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420047590",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029502",
      "ndc_label_name": "Temazepam Capsule 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781269344",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722041314",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781269375",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729005053",
      "ndc_label_name": "Temozolomide CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729005054",
      "ndc_label_name": "Temozolomide CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571081841",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089280",
      "ndc_label_name": "Temozolomide CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571081851",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089272",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043001314",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923070814",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722041331",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089221",
      "ndc_label_name": "Temozolomide CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268076211",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382075396",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980033505",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268076212",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834014314",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382075367",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089274",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923070705",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162080351",
      "ndc_label_name": "Temozolomide CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834014305",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877053907",
      "ndc_label_name": "Temozolomide CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559092251",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877053914",
      "ndc_label_name": "Temozolomide CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559092214",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043001305",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980033514",
      "ndc_label_name": "Temozolomide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162080314",
      "ndc_label_name": "Temozolomide CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571081941",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722041431",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781269475",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729012953",
      "ndc_label_name": "Temozolomide CAPSULE 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382075467",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729012954",
      "ndc_label_name": "Temozolomide CAPSULE 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781269444",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335092974",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834014414",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335092980",
      "ndc_label_name": "Temozolomide CAPSULE 140 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571081951",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559092314",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335092972",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162080414",
      "ndc_label_name": "Temozolomide CAPSULE 140 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722041414",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923070905",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335092921",
      "ndc_label_name": "Temozolomide CAPSULE 140 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923071014",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980033614",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980033605",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162080451",
      "ndc_label_name": "Temozolomide CAPSULE 140 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054014",
      "ndc_label_name": "Temozolomide CAPSULE 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559092351",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054007",
      "ndc_label_name": "Temozolomide CAPSULE 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043001405",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834014405",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382075496",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043001414",
      "ndc_label_name": "Temozolomide Capsule 140 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781269544",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043001505",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781269575",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335093021",
      "ndc_label_name": "Temozolomide CAPSULE 180 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571082051",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722041531",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571082041",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722041514",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729013053",
      "ndc_label_name": "Temozolomide CAPSULE 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923071105",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729013054",
      "ndc_label_name": "Temozolomide CAPSULE 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559092451",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335093072",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559092414",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923071214",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335093074",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054107",
      "ndc_label_name": "Temozolomide CAPSULE 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162080514",
      "ndc_label_name": "Temozolomide CAPSULE 180 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335093080",
      "ndc_label_name": "Temozolomide CAPSULE 180 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834014514",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382075567",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043001514",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162080551",
      "ndc_label_name": "Temozolomide CAPSULE 180 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054114",
      "ndc_label_name": "Temozolomide CAPSULE 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382075596",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834014505",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980033705",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980033714",
      "ndc_label_name": "Temozolomide Capsule 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089121",
      "ndc_label_name": "Temozolomide CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781269275",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089172",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729004954",
      "ndc_label_name": "Temozolomide CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722041231",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571081741",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781269244",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571081751",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089180",
      "ndc_label_name": "Temozolomide CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729004953",
      "ndc_label_name": "Temozolomide CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268076112",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923070614",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089174",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980033405",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923070505",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559092114",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877053814",
      "ndc_label_name": "Temozolomide CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722041214",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559092151",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162080214",
      "ndc_label_name": "Temozolomide CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162080251",
      "ndc_label_name": "Temozolomide CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382075267",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834014214",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877053807",
      "ndc_label_name": "Temozolomide CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382075296",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268076111",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980033414",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043001205",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043001214",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834014205",
      "ndc_label_name": "Temozolomide Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162080651",
      "ndc_label_name": "Temozolomide CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834014605",
      "ndc_label_name": "Temozolomide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729005153",
      "ndc_label_name": "Temozolomide CAPSULE 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559092551",
      "ndc_label_name": "Temozolomide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923071305",
      "ndc_label_name": "Temozolomide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722041631",
      "ndc_label_name": "Temozolomide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089374",
      "ndc_label_name": "Temozolomide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781269675",
      "ndc_label_name": "Temozolomide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877054207",
      "ndc_label_name": "Temozolomide CAPSULE 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980033805",
      "ndc_label_name": "Temozolomide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089380",
      "ndc_label_name": "Temozolomide CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571082151",
      "ndc_label_name": "Temozolomide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382075696",
      "ndc_label_name": "Temozolomide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043001605",
      "ndc_label_name": "Temozolomide Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089080",
      "ndc_label_name": "Temozolomide CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980033314",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571081641",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980033305",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729004853",
      "ndc_label_name": "Temozolomide CAPSULE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781269144",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781269175",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729004854",
      "ndc_label_name": "Temozolomide CAPSULE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923070414",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043001114",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16571081651",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877053707",
      "ndc_label_name": "Temozolomide CAPSULE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722041131",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722041114",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089072",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382075167",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559092051",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089021",
      "ndc_label_name": "Temozolomide CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59923070305",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73043001105",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335089074",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62559092014",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834013205",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "75834013214",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162080114",
      "ndc_label_name": "Temozolomide CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65162080151",
      "ndc_label_name": "Temozolomide CAPSULE 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382075196",
      "ndc_label_name": "Temozolomide Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877053714",
      "ndc_label_name": "Temozolomide CAPSULE 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268075811",
      "ndc_label_name": "Tenofovir Disoproxil Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904682104",
      "ndc_label_name": "Tenofovir Disoproxil Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090720200",
      "ndc_label_name": "Tenofovir Disoproxil Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722053530",
      "ndc_label_name": "Tenofovir Disoproxil Fumarate TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135046630",
      "ndc_label_name": "Tenofovir Disoproxil Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714082001",
      "ndc_label_name": "Tenofovir Disoproxil Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097053302",
      "ndc_label_name": "Tenofovir Disoproxil Fumarate TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009607",
      "ndc_label_name": "Tenofovir Disoproxil Fumarate TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291080030",
      "ndc_label_name": "Tenofovir Disoproxil Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69076010503",
      "ndc_label_name": "Tenofovir Disoproxil Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385090103",
      "ndc_label_name": "Tenofovir Disoproxil Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268075812",
      "ndc_label_name": "Tenofovir Disoproxil Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380071404",
      "ndc_label_name": "Tenofovir Disoproxil Fumarate TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862042130",
      "ndc_label_name": "Tenofovir Disoproxil Fumarate TABLET 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921010533",
      "ndc_label_name": "Tenofovir Disoproxil Fumarate Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241028801",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440848530",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268076415",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268076411",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155073501",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291082010",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155073510",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090065700",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090065701",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440848590",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746038309",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071560",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746038310",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959082860",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090785101",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959082805",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700075090",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689079201",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610047860",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085460",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452033020",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544058130",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407073210",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135045890",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746038306",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689079210",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544058160",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544058153",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085430",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085480",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085453",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090785100",
      "ndc_label_name": "Terazosin HCl Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155073801",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291082310",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689096110",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155073810",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440848890",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268076715",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407073510",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440848830",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689096101",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268076711",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629243901",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059480",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090237101",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056480",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746038606",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241029101",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746038610",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054680",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056430",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056453",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135046190",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170200",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746038609",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056460",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452033320",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610054660",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610078060",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059460",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076260",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610076280",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610078080",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162170201",
      "ndc_label_name": "Terazosin HCl Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746038410",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440848692",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689085501",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135045990",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155073610",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440848630",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262301",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440848690",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072053",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155073601",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056280",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056230",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241028901",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056260",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268076511",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056270",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072060",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689085510",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051030",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056294",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268076515",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406401",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407073310",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291082110",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610085680",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788817103",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051053",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090262300",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056292",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051094",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406403",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746038406",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452033120",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746038409",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051080",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056253",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162218200",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051060",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452033132",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051070",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051092",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069860",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072030",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072070",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072080",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072092",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610072094",
      "ndc_label_name": "Terazosin HCl Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291082210",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155073710",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746038509",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440848730",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440848790",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689088210",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059580",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155073701",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999022790",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544008453",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544008480",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090155900",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090155901",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268076615",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610078660",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24689088201",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610050380",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610050360",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056353",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268076611",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407073410",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760031690",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162218300",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27241029001",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959082960",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610078680",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056360",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544008430",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746038506",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135046090",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056330",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746038510",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084030",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544056380",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084060",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544008460",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084070",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452033232",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760081690",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452033220",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084053",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059560",
      "ndc_label_name": "Terazosin HCl Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090127800",
      "ndc_label_name": "Terbinafine HCl Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68788404401",
      "ndc_label_name": "Terbinafine HCl Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917009374",
      "ndc_label_name": "Terbinafine HCl CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090581000",
      "ndc_label_name": "Terbinafine HCl Cream 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672208001",
      "ndc_label_name": "Terbinafine HCl CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51672208002",
      "ndc_label_name": "Terbinafine HCl CREAM 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43063090620",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440848940",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357501",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043041003",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090365400",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714079501",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42043041001",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714079502",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090104800",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063059890",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991052601",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090690",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118025008",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090365401",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353089316",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063090642",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919045130",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687090921",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687090911",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320601",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919045190",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090730001",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320600",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090104801",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629199301",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187079235",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187079230",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090730000",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135057290",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959099930",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629280703",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357500",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772201",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187079245",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292022501",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991052633",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629280701",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135057230",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629280706",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959099921",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097085902",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629280704",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69292022530",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429022230",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862007930",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097073107",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097073102",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745003",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205015230",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788718703",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006135",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629280702",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788745001",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205049242",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006130",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788772203",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205049290",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012714",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804022030",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629280705",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097085907",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025703",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012745",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025701",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804022042",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162253901",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205015235",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452035113",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205049230",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025706",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025704",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162159501",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025707",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452035120",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162253903",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189024330",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012730",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039442",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012735",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039490",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205049245",
      "ndc_label_name": "Terbinafine HCl Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025702",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025705",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335025708",
      "ndc_label_name": "Terbinafine HCl TABLET 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527131801",
      "ndc_label_name": "Terbutaline Sulfate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440849006",
      "ndc_label_name": "Terbutaline Sulfate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356036730",
      "ndc_label_name": "Terbutaline Sulfate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440849008",
      "ndc_label_name": "Terbutaline Sulfate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135057901",
      "ndc_label_name": "Terbutaline Sulfate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135057932",
      "ndc_label_name": "Terbutaline Sulfate TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115261101",
      "ndc_label_name": "Terbutaline Sulfate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093800",
      "ndc_label_name": "Terbutaline Sulfate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093855",
      "ndc_label_name": "Terbutaline Sulfate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979013201",
      "ndc_label_name": "Terbutaline Sulfate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093860",
      "ndc_label_name": "Terbutaline Sulfate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093830",
      "ndc_label_name": "Terbutaline Sulfate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559072101",
      "ndc_label_name": "Terbutaline Sulfate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135052490",
      "ndc_label_name": "Terbutaline Sulfate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093890",
      "ndc_label_name": "Terbutaline Sulfate Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00115262201",
      "ndc_label_name": "Terbutaline Sulfate TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093930",
      "ndc_label_name": "Terbutaline Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559072201",
      "ndc_label_name": "Terbutaline Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135058001",
      "ndc_label_name": "Terbutaline Sulfate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440849208",
      "ndc_label_name": "Terbutaline Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093955",
      "ndc_label_name": "Terbutaline Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135052590",
      "ndc_label_name": "Terbutaline Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440849204",
      "ndc_label_name": "Terbutaline Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527131101",
      "ndc_label_name": "Terbutaline Sulfate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093990",
      "ndc_label_name": "Terbutaline Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135058032",
      "ndc_label_name": "Terbutaline Sulfate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093900",
      "ndc_label_name": "Terbutaline Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979013301",
      "ndc_label_name": "Terbutaline Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205093960",
      "ndc_label_name": "Terbutaline Sulfate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959081103",
      "ndc_label_name": "Terconazole Cream 0.4 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999076245",
      "ndc_label_name": "Terconazole Cream 0.4 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118990304",
      "ndc_label_name": "Terconazole CREAM 0.4 % VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090091700",
      "ndc_label_name": "Terconazole Cream 0.4 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168034646",
      "ndc_label_name": "Terconazole CREAM 0.4 % VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090626600",
      "ndc_label_name": "Terconazole Cream 0.4 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130406",
      "ndc_label_name": "Terconazole CREAM 0.4 % VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002081367",
      "ndc_label_name": "Terconazole CREAM 0.4 % VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672130200",
      "ndc_label_name": "Terconazole Cream 0.8 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090119600",
      "ndc_label_name": "Terconazole Cream 0.8 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168034720",
      "ndc_label_name": "Terconazole Cream 0.8 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090629900",
      "ndc_label_name": "Terconazole Cream 0.8 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002072458",
      "ndc_label_name": "Terconazole Cream 0.8 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629883701",
      "ndc_label_name": "Terconazole Cream 0.8 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713055273",
      "ndc_label_name": "Terconazole SUPPOSITORY 80 MG VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802071700",
      "ndc_label_name": "Terconazole Suppository 80 MG Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802071708",
      "ndc_label_name": "Terconazole SUPPOSITORY 80 MG VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598028130",
      "ndc_label_name": "Teriflunomide Tablet 14 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729040010",
      "ndc_label_name": "Teriflunomide Tablet 14 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480315656",
      "ndc_label_name": "Teriflunomide Tablet 14 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781575531",
      "ndc_label_name": "Teriflunomide Tablet 14 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377001811",
      "ndc_label_name": "Teriflunomide Tablet 14 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291083130",
      "ndc_label_name": "Teriflunomide Tablet 14 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722024730",
      "ndc_label_name": "Teriflunomide Tablet 14 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710111503",
      "ndc_label_name": "Teriflunomide Tablet 14 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651005530",
      "ndc_label_name": "Teriflunomide Tablet 14 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505447803",
      "ndc_label_name": "Teriflunomide Tablet 14 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332031430",
      "ndc_label_name": "Teriflunomide Tablet 14 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462042430",
      "ndc_label_name": "Teriflunomide Tablet 14 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238130406",
      "ndc_label_name": "Teriflunomide Tablet 14 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512085128",
      "ndc_label_name": "Teriflunomide Tablet 14 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598028230",
      "ndc_label_name": "Teriflunomide Tablet 7 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291083030",
      "ndc_label_name": "Teriflunomide Tablet 7 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00480315756",
      "ndc_label_name": "Teriflunomide Tablet 7 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729039910",
      "ndc_label_name": "Teriflunomide Tablet 7 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651005430",
      "ndc_label_name": "Teriflunomide Tablet 7 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70377001711",
      "ndc_label_name": "Teriflunomide Tablet 7 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238130306",
      "ndc_label_name": "Teriflunomide Tablet 7 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462042330",
      "ndc_label_name": "Teriflunomide Tablet 7 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332031330",
      "ndc_label_name": "Teriflunomide Tablet 7 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781574731",
      "ndc_label_name": "Teriflunomide Tablet 7 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722024630",
      "ndc_label_name": "Teriflunomide Tablet 7 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505447703",
      "ndc_label_name": "Teriflunomide Tablet 7 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70512085028",
      "ndc_label_name": "Teriflunomide Tablet 7 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710111403",
      "ndc_label_name": "Teriflunomide Tablet 7 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00143975001",
      "ndc_label_name": "Testosterone Enanthate Solution 200 MG/ML Intramuscular",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722082111",
      "ndc_label_name": "Tetrabenazine TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335027723",
      "ndc_label_name": "Tetrabenazine TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598039467",
      "ndc_label_name": "Tetrabenazine TABLET 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155093863",
      "ndc_label_name": "Tetrabenazine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436010109",
      "ndc_label_name": "Tetrabenazine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505388207",
      "ndc_label_name": "Tetrabenazine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224042510",
      "ndc_label_name": "Tetrabenazine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291080630",
      "ndc_label_name": "Tetrabenazine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094090510",
      "ndc_label_name": "Tetrabenazine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452011721",
      "ndc_label_name": "Tetrabenazine TABLET 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407048012",
      "ndc_label_name": "Tetrabenazine Tablet 12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682042112",
      "ndc_label_name": "Tetrabenazine TABLET 12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722082211",
      "ndc_label_name": "Tetrabenazine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598039567",
      "ndc_label_name": "Tetrabenazine TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505388307",
      "ndc_label_name": "Tetrabenazine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51224042610",
      "ndc_label_name": "Tetrabenazine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "47335017923",
      "ndc_label_name": "Tetrabenazine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407048112",
      "ndc_label_name": "Tetrabenazine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155093963",
      "ndc_label_name": "Tetrabenazine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69452011821",
      "ndc_label_name": "Tetrabenazine TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682042225",
      "ndc_label_name": "Tetrabenazine TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291080730",
      "ndc_label_name": "Tetrabenazine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70436010209",
      "ndc_label_name": "Tetrabenazine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68094080510",
      "ndc_label_name": "Tetrabenazine Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59572021015",
      "ndc_label_name": "Thalomid CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121482040",
      "ndc_label_name": "Theophylline Elixir 80 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121479415",
      "ndc_label_name": "Theophylline Elixir 80 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121082016",
      "ndc_label_name": "Theophylline Elixir 80 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00121482015",
      "ndc_label_name": "Theophylline Elixir 80 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "23155074101",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315022601",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480331001",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440853294",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440853220",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578017301",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440853290",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219204501",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789044101",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70095001701",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722007701",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452026720",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440853230",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380024301",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135045790",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462072101",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033005901",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002531",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291092201",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480330901",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462072201",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033006001",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380024401",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155074201",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70095001801",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578017401",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219204601",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722007801",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69315022701",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332002631",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789044201",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 12 Hour 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033000101",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378048601",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407031801",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858070101",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462038001",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367041401",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 24 Hour 400 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42858070201",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 24 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462035601",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 24 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367041501",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 24 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407031901",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 24 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29033000201",
      "ndc_label_name": "Theophylline ER Tablet Extended Release 24 Hour 600 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999055651",
      "ndc_label_name": "Theophylline Solution 80 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68999055624",
      "ndc_label_name": "Theophylline Solution 80 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135055647",
      "ndc_label_name": "Theophylline Solution 80 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687025871",
      "ndc_label_name": "Theophylline Solution 80 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "54838055680",
      "ndc_label_name": "Theophylline Solution 80 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135060408",
      "ndc_label_name": "Theophylline SOLUTION 80 MG/15ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687025844",
      "ndc_label_name": "Theophylline Solution 80 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135055624",
      "ndc_label_name": "Theophylline Solution 80 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335290901",
      "ndc_label_name": "Theophylline Solution 80 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27808003301",
      "ndc_label_name": "Theophylline SOLUTION 80 MG/15ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62135055651",
      "ndc_label_name": "Theophylline Solution 80 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162203802",
      "ndc_label_name": "Theophylline Solution 80 MG/15ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378061201",
      "ndc_label_name": "Thioridazine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135093490",
      "ndc_label_name": "Thioridazine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079056501",
      "ndc_label_name": "Thioridazine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079056520",
      "ndc_label_name": "Thioridazine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079058001",
      "ndc_label_name": "Thioridazine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378061801",
      "ndc_label_name": "Thioridazine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079058020",
      "ndc_label_name": "Thioridazine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135093990",
      "ndc_label_name": "Thioridazine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079056620",
      "ndc_label_name": "Thioridazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378061401",
      "ndc_label_name": "Thioridazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079056601",
      "ndc_label_name": "Thioridazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135093690",
      "ndc_label_name": "Thioridazine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135093890",
      "ndc_label_name": "Thioridazine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079056701",
      "ndc_label_name": "Thioridazine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079056720",
      "ndc_label_name": "Thioridazine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378061601",
      "ndc_label_name": "Thioridazine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954001410",
      "ndc_label_name": "Thiothixene Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378100101",
      "ndc_label_name": "Thiothixene Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219167301",
      "ndc_label_name": "Thiothixene Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407027501",
      "ndc_label_name": "Thiothixene Capsule 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378501001",
      "ndc_label_name": "Thiothixene Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219167601",
      "ndc_label_name": "Thiothixene Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407027801",
      "ndc_label_name": "Thiothixene Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954001710",
      "ndc_label_name": "Thiothixene Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079058901",
      "ndc_label_name": "Thiothixene Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079058920",
      "ndc_label_name": "Thiothixene Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219167401",
      "ndc_label_name": "Thiothixene Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378200201",
      "ndc_label_name": "Thiothixene Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407027601",
      "ndc_label_name": "Thiothixene Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954001510",
      "ndc_label_name": "Thiothixene Capsule 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378300501",
      "ndc_label_name": "Thiothixene Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954001610",
      "ndc_label_name": "Thiothixene Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407027701",
      "ndc_label_name": "Thiothixene Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079058801",
      "ndc_label_name": "Thiothixene Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219167501",
      "ndc_label_name": "Thiothixene Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079058820",
      "ndc_label_name": "Thiothixene Capsule 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08373073000",
      "ndc_label_name": "Threshold IMT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58468003001",
      "ndc_label_name": "Thyrogen Solution Reconstituted 0.9 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58468003002",
      "ndc_label_name": "Thyrogen Solution Reconstituted 0.9 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559074401",
      "ndc_label_name": "Thyroid Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69680016900",
      "ndc_label_name": "Thyroid Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69680016500",
      "ndc_label_name": "Thyroid Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559074001",
      "ndc_label_name": "Thyroid Tablet 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69680016600",
      "ndc_label_name": "Thyroid Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559074101",
      "ndc_label_name": "Thyroid Tablet 30 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69680016700",
      "ndc_label_name": "Thyroid Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559074201",
      "ndc_label_name": "Thyroid Tablet 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69680016800",
      "ndc_label_name": "Thyroid Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559074301",
      "ndc_label_name": "Thyroid Tablet 90 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093807256",
      "ndc_label_name": "tiaGABine HCl Tablet 12 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205008630",
      "ndc_label_name": "tiaGABine HCl Tablet 12 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093807656",
      "ndc_label_name": "tiaGABine HCl Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205008730",
      "ndc_label_name": "tiaGABine HCl Tablet 16 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756020083",
      "ndc_label_name": "TiaGABine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205008430",
      "ndc_label_name": "tiaGABine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093503056",
      "ndc_label_name": "tiaGABine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093503156",
      "ndc_label_name": "tiaGABine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756022483",
      "ndc_label_name": "TiaGABine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72205008530",
      "ndc_label_name": "tiaGABine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187261290",
      "ndc_label_name": "Tiazac CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187261230",
      "ndc_label_name": "Tiazac CAPSULE EXTENDED RELEASE 24 HOUR 120 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187261330",
      "ndc_label_name": "Tiazac CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187261390",
      "ndc_label_name": "Tiazac CAPSULE EXTENDED RELEASE 24 HOUR 180 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187261430",
      "ndc_label_name": "Tiazac CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187261490",
      "ndc_label_name": "Tiazac CAPSULE EXTENDED RELEASE 24 HOUR 240 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187261590",
      "ndc_label_name": "Tiazac CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00187261530",
      "ndc_label_name": "Tiazac CAPSULE EXTENDED RELEASE 24 HOUR 300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70069070201",
      "ndc_label_name": "Timolol Maleate Solution 0.25 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314022615",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.25 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60758080210",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.25 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314022610",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.25 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980051315",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.25 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60758080205",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.25 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980051305",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.25 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980051301",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.25 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069070301",
      "ndc_label_name": "Timolol Maleate Solution 0.25 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81469020905",
      "ndc_label_name": "Timolol Maleate Solution 0.25 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756065415",
      "ndc_label_name": "Timolol Maleate Solution 0.25 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81469020910",
      "ndc_label_name": "Timolol Maleate Solution 0.25 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314022605",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.25 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069070101",
      "ndc_label_name": "Timolol Maleate Solution 0.25 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756065530",
      "ndc_label_name": "Timolol Maleate Solution 0.25 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478028810",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478028811",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090783700",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478028812",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571040421",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145015301",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571040488",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090055800",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314022705",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980051405",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315032515",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60758080105",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315032505",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145015401",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090185200",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60758080110",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81469021010",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65145015201",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090344100",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980051401",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090576900",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069070601",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314022715",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314022710",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68682081305",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069070701",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315032510",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980051415",
      "ndc_label_name": "Timolol Maleate SOLUTION 0.5 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069070801",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "81469021005",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756065615",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70756065730",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82260081305",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603054001",
      "ndc_label_name": "Timolol Maleate Solution 0.5 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00113042654",
      "ndc_label_name": "Tioconazole-1 Ointment 6.5 % Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "36800042654",
      "ndc_label_name": "Tioconazole-1 OINTMENT 6.5 % VAGINAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00363042654",
      "ndc_label_name": "Tioconazole-1 OINTMENT 6.5 % VAGINAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00363033082",
      "ndc_label_name": "Tioconazole-1 OINTMENT 6.5 % VAGINAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000035701",
      "ndc_label_name": "Tioconazole-1 Ointment 6.5 % Vaginal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49702025537",
      "ndc_label_name": "Tivicay PD Tablet Soluble 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49702022613",
      "ndc_label_name": "Tivicay Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49702022713",
      "ndc_label_name": "Tivicay Tablet 25 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49702022813",
      "ndc_label_name": "Tivicay TABLET 50 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760074807",
      "ndc_label_name": "Tivicay Tablet 50 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440851020",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356066230",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440851012",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300016815",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356066218",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017101",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086812",
      "ndc_label_name": "TiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185003451",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356066214",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356066260",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300016810",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999058415",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356066290",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090081101",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207801",
      "ndc_label_name": "TiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086860",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436675503",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353016709",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291080815",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090081300",
      "ndc_label_name": "TiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063086830",
      "ndc_label_name": "TiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436025102",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436025105",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090207800",
      "ndc_label_name": "TiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069190",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771601",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090081100",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090771600",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090081301",
      "ndc_label_name": "TiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760069430",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436675501",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069102",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050289",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436025103",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069120",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268075911",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268075915",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760069460",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069145",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069105",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505025102",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436675502",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002141802",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002141803",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436025101",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081160",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069160",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069130",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505025103",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022030",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760069404",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760025304",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069100",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629320901",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760071904",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760078204",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760078215",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022090",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760069415",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081115",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069124",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644409",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187091030",
      "ndc_label_name": "TiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081190",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081172",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187091060",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760069490",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187091090",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069125",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799108",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237001",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629320902",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629320904",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629320903",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760071915",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980065810",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959069163",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799109",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267074991",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629320905",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267074960",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980065815",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081130",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000301",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111017910",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045509",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799103",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644408",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877061315",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267074984",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778203",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179903",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111017915",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267074990",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205031130",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778208",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644401",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084077595",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778206",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189059930",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050218",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644403",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000303",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000309",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788799106",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788644406",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778209",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032630",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760078290",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518318100",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000306",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610034509",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000308",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000304",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179901",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420022890",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022060",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000307",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335042402",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162164100",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189059990",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335042403",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179904",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189059960",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022072",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032690",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018702",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578009610",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420022830",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420022818",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578009621",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018701",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629853301",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050002",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043603",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425018703",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042501",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042503",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032677",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050003",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267074900",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050001",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425042502",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420022860",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267074928",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043601",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084077525",
      "ndc_label_name": "TiZANidine HCl TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043602",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788949709",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000302",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335000305",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335042401",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335179902",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189059982",
      "ndc_label_name": "tiZANidine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300016915",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017201",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440851220",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634024771",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00185440051",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634024760",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045530",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904641861",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084102",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353091418",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999034730",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714017202",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300016910",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300016903",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045590",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045515",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084104",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999034760",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220803",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045520",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999034701",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291080915",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084100",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045560",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084107",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084002",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220804",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084003",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084006",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063045540",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084103",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999034715",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576707",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084004",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068963",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576704",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576700",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084106",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675600",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999034790",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068942",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220806",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187014560",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576706",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576702",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220800",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436025203",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084000",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002143709",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090576703",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788636506",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675602",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268076015",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068902",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436675603",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090084007",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760050590",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675604",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778101",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675700",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436025201",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760026330",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068920",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220802",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919019630",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675607",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874108",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436025204",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436118002",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760050530",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068921",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220807",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022115",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268076011",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788951406",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436118001",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436118003",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187049330",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068960",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675603",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022130",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436025202",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934002130",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436675604",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436675601",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167302",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050389",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090675606",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022172",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436675602",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101601",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068915",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068945",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980065910",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505025202",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090788900",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187067314",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068930",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101604",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068990",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002143703",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980065915",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760050504",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068905",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187067330",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289078460",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011430",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664050318",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111018010",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267059815",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187049315",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068908",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167305",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000960",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022830",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118018001",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111018015",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267059828",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167307",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760026390",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267059845",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187014530",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086430",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505025203",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760026304",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267059891",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167310",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919019640",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788636508",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187014590",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086453",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760026315",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760050515",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874102",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778106",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022160",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874103",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187049360",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420022990",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760026360",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919019660",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880208",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880202",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022186",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874106",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629237101",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045401",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760050560",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022190",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788951403",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880209",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187049390",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880203",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267059884",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045404",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919019672",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167301",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788951409",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335073701",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187067360",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880206",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877061415",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008009030",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919019690",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084064511",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518365802",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335073704",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167304",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934081130",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084064501",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335232502",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000930",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778108",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335073702",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077616",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788636503",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335091406",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778103",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077630",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187000990",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874109",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335091404",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077670",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788636509",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101602",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778109",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086416",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187049314",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518013300",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335091405",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086460",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101605",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335232503",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788880201",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032530",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187067390",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335073709",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101603",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032720",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011453",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016753",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934002190",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420022930",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167303",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035560",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335101606",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002302",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016216",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035530",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335073705",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578009710",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629167306",
      "ndc_label_name": "TiZANidine HCl TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077660",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610011460",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045304",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022853",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077675",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335073708",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045402",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084064565",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060260",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016730",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002402",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162164200",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002404",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335091402",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008009001",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788778102",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509118001",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077653",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060290",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335091408",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788874101",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086480",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578009776",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335091409",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518365801",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189060230",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032577",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016716",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335073700",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032590",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002303",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610016760",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335073703",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420022960",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002401",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610022860",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335073706",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509118002",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002403",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035553",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335091400",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610077680",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008009060",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578009721",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335091401",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002304",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335091403",
      "ndc_label_name": "TiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045302",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335232501",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045303",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610035516",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045403",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045116",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002201",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002202",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425002301",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425045301",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008009090",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509118003",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509118006",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "85509118009",
      "ndc_label_name": "tiZANidine HCl Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090212700",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090419000",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959010803",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "17478029010",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002092371",
      "ndc_label_name": "Tobramycin SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208029005",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62332051805",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314064305",
      "ndc_label_name": "Tobramycin SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118990205",
      "ndc_label_name": "Tobramycin SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919022405",
      "ndc_label_name": "Tobramycin SOLUTION 0.3 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069013101",
      "ndc_label_name": "Tobramycin SOLUTION 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090048600",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425034101",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788725205",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760058305",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700074705",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919064205",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187090205",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72266019601",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788824805",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205010105",
      "ndc_label_name": "Tobramycin Solution 0.3 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629957101",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090113500",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314064725",
      "ndc_label_name": "Tobramycin-Dexamethasone SUSPENSION 0.3-0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574403110",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208029505",
      "ndc_label_name": "Tobramycin-Dexamethasone SUSPENSION 0.3-0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574403105",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238137506",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208029510",
      "ndc_label_name": "Tobramycin-Dexamethasone SUSPENSION 0.3-0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788408105",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090189300",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425026001",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00574403125",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "24208029525",
      "ndc_label_name": "Tobramycin-Dexamethasone SUSPENSION 0.3-0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959098410",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162112802",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335284001",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959098401",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090191400",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314064705",
      "ndc_label_name": "Tobramycin-Dexamethasone SUSPENSION 0.3-0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090113600",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629957201",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090726700",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162112804",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002081271",
      "ndc_label_name": "Tobramycin-Dexamethasone SUSPENSION 0.3-0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162112807",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314064710",
      "ndc_label_name": "Tobramycin-Dexamethasone SUSPENSION 0.3-0.1 % OPHTHALMIC",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425036601",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700091505",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629957001",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238137302",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335289101",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69238137403",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335285401",
      "ndc_label_name": "Tobramycin-Dexamethasone Suspension 0.3-0.1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16169040403",
      "ndc_label_name": "Today Sponge 1000 MG VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00378021501",
      "ndc_label_name": "TOLBUTamide Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00536132926",
      "ndc_label_name": "Tolnaftate Powder 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904072645",
      "ndc_label_name": "Tolnaftate Powder 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536145326",
      "ndc_label_name": "Tolnaftate Powder 1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896019945",
      "ndc_label_name": "Tolnaftate POWDER 1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "16571012606",
      "ndc_label_name": "Tolterodine Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205031990",
      "ndc_label_name": "Tolterodine Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135070605",
      "ndc_label_name": "Tolterodine Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762017006",
      "ndc_label_name": "Tolterodine Tartrate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722080560",
      "ndc_label_name": "Tolterodine Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135070660",
      "ndc_label_name": "Tolterodine Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093001006",
      "ndc_label_name": "Tolterodine Tartrate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73152002660",
      "ndc_label_name": "Tolterodine Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009709",
      "ndc_label_name": "Tolterodine Tartrate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762017001",
      "ndc_label_name": "Tolterodine Tartrate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300023916",
      "ndc_label_name": "Tolterodine Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009715",
      "ndc_label_name": "Tolterodine Tartrate TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093001805",
      "ndc_label_name": "Tolterodine Tartrate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571012706",
      "ndc_label_name": "Tolterodine Tartrate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300024016",
      "ndc_label_name": "Tolterodine Tartrate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135070705",
      "ndc_label_name": "Tolterodine Tartrate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722080660",
      "ndc_label_name": "Tolterodine Tartrate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093001806",
      "ndc_label_name": "Tolterodine Tartrate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135070760",
      "ndc_label_name": "Tolterodine Tartrate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722080605",
      "ndc_label_name": "Tolterodine Tartrate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762080006",
      "ndc_label_name": "Tolterodine Tartrate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571012750",
      "ndc_label_name": "Tolterodine Tartrate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009815",
      "ndc_label_name": "Tolterodine Tartrate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73152002705",
      "ndc_label_name": "Tolterodine Tartrate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342009809",
      "ndc_label_name": "Tolterodine Tartrate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762080002",
      "ndc_label_name": "Tolterodine Tartrate TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73152002760",
      "ndc_label_name": "Tolterodine Tartrate Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382000414",
      "ndc_label_name": "Topiramate CAPSULE SPRINKLE 15 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093733506",
      "ndc_label_name": "Topiramate Capsule Sprinkle 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651045260",
      "ndc_label_name": "Topiramate Capsule Sprinkle 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407089360",
      "ndc_label_name": "Topiramate Capsule Sprinkle 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877086860",
      "ndc_label_name": "Topiramate Capsule Sprinkle 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979021004",
      "ndc_label_name": "Topiramate Capsule Sprinkle 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155089406",
      "ndc_label_name": "Topiramate Capsule Sprinkle 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462021860",
      "ndc_label_name": "Topiramate Capsule Sprinkle 15 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24979021104",
      "ndc_label_name": "Topiramate Capsule Sprinkle 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407089460",
      "ndc_label_name": "Topiramate Capsule Sprinkle 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462021960",
      "ndc_label_name": "Topiramate Capsule Sprinkle 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651045360",
      "ndc_label_name": "Topiramate Capsule Sprinkle 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877086960",
      "ndc_label_name": "Topiramate Capsule Sprinkle 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155089506",
      "ndc_label_name": "Topiramate Capsule Sprinkle 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093733606",
      "ndc_label_name": "Topiramate Capsule Sprinkle 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382000514",
      "ndc_label_name": "Topiramate CAPSULE SPRINKLE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781227660",
      "ndc_label_name": "Topiramate CAPSULE SPRINKLE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571070706",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018305",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904692961",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060530",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571070710",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063072928",
      "ndc_label_name": "Topiramate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069653",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063060560",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063072907",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335071113",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011705",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069645",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069660",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069680",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090224801",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063072930",
      "ndc_label_name": "Topiramate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959064360",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090530901",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011710",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335071186",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090338901",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090224800",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090338902",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090338900",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919018530",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700069160",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011716",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090689500",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090375202",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090338903",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919021330",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090530902",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919018560",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429077110",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018360",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700069190",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700021730",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959064330",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043960",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700069130",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883505",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919021390",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063072921",
      "ndc_label_name": "Topiramate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760051460",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919021360",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099530",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187069630",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099560",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012412",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081790",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063072960",
      "ndc_label_name": "Topiramate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919021372",
      "ndc_label_name": "Topiramate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081730",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919069160",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382014005",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919043930",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049230",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187080190",
      "ndc_label_name": "Topiramate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069630",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919069130",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756071186",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084034411",
      "ndc_label_name": "Topiramate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746806",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756071113",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425037302",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382014014",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090224802",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071081330",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187069690",
      "ndc_label_name": "Topiramate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032503",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032501",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883503",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048803",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462010905",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090375200",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462010910",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862017360",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049253",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000421",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019590",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746803",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462010960",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090530900",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012403",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746805",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009013705",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865031560",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000460",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012415",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746809",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090530903",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789000430",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335032502",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883509",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020202",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039803",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027990",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205019530",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436995101",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282028060",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039801",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335231802",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039802",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027930",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429077160",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049260",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919081760",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425037303",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187006030",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027960",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187028360",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425037301",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187069660",
      "ndc_label_name": "Topiramate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048801",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629055990",
      "ndc_label_name": "Topiramate TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425048802",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084034401",
      "ndc_label_name": "Topiramate TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883506",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049245",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865031510",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282028010",
      "ndc_label_name": "Topiramate Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436995202",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018460",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069715",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571070806",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011810",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382014105",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011805",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571070810",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118071203",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335071213",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069730",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018405",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335071286",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049330",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700022660",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011816",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382014114",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118071206",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919021260",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069760",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756071213",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420028090",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082360",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069780",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071081030",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462011060",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629494701",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429077260",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406706",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406705",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756071286",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429077210",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406709",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335111602",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084034511",
      "ndc_label_name": "Topiramate TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862017460",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012512",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282028110",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462011010",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049315",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335111601",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282028160",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084034521",
      "ndc_label_name": "Topiramate TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071018130",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049360",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420028030",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406703",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012503",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012515",
      "ndc_label_name": "Topiramate TABLET 200 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865031610",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865031660",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420028060",
      "ndc_label_name": "Topiramate Tablet 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018105",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904692861",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571070510",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571070506",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011516",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090210201",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011505",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073515",
      "ndc_label_name": "Topiramate TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073590",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063057315",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011510",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722027805",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018160",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090585302",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073560",
      "ndc_label_name": "Topiramate TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069553",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090682700",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073530",
      "ndc_label_name": "Topiramate TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063057330",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090393100",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099860",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760075260",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099830",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069570",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436122004",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069530",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069560",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700022730",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090210202",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919067990",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335070713",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069580",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760007560",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090585301",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090461401",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919088372",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090706700",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082460",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335070786",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090461400",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919019090",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436994903",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090461402",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013805",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436122003",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919088330",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090210200",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044101",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919067930",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959044160",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090585300",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788677005",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700022760",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071080830",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760007530",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756070713",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919067972",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700022727",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436122001",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881705",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700022790",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788677006",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919067960",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756070786",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187011860",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919019060",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436122002",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012212",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429076910",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746006",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919067986",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788677009",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077390",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082430",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082490",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205021490",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919019030",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205021460",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862017160",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746003",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071080860",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077330",
      "ndc_label_name": "Topiramate TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919088360",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027830",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919088386",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282027810",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462010860",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934074890",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881703",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077360",
      "ndc_label_name": "Topiramate TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187011830",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425057604",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462010810",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027890",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205020230",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205023360",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881708",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013814",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084034201",
      "ndc_label_name": "Topiramate TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001260",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788677003",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020801",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335972702",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048580",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012215",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881709",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084034211",
      "ndc_label_name": "Topiramate TABLET 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865031310",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788746009",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028802",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048530",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282027860",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934014930",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788949908",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462010805",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425057601",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335054802",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425057603",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048560",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020803",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934074860",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788881706",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028801",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048570",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205021430",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788973008",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028804",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425020802",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865031360",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012203",
      "ndc_label_name": "Topiramate TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027860",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425028803",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425057602",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001290",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009013505",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001227",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001230",
      "ndc_label_name": "Topiramate Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220302",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073407",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722027905",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018260",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571070606",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571070610",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073460",
      "ndc_label_name": "Topiramate TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722018205",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090682800",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099760",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073421",
      "ndc_label_name": "Topiramate TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063061230",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011605",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011610",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335071013",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "47335071086",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436995001",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220300",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099730",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099721",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073430",
      "ndc_label_name": "Topiramate TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300011616",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090392601",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220303",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959099460",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090346103",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090346100",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220301",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013903",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063061260",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187075890",
      "ndc_label_name": "Topiramate TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090775700",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700022860",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959099402",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013901",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090346101",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436995003",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090392602",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071081130",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013902",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036960",
      "ndc_label_name": "Topiramate TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760009460",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700089460",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090346102",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700022890",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429077010",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071081190",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436995002",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756071086",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760057760",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919031890",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090392600",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017260",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760009490",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934060630",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959099430",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187075830",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017290",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735103",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090392603",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082530",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760057790",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865031460",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959099490",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084034301",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756071013",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735105",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919031860",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082590",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919017272",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009202",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700089430",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462015305",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187047960",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934013330",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919036972",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735109",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919031830",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205018790",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700089490",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882809",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862017260",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081960",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187022890",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012315",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919082560",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049503",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429077060",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518193705",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071081160",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934073360",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187075807",
      "ndc_label_name": "Topiramate TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335106407",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187022830",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335106401",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919018960",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048630",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013905",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019330",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187075860",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048680",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382013914",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019360",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919031872",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425021403",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735101",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009013605",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084034311",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001130",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462015360",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001160",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882803",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882806",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462015310",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882801",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882805",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019353",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788735106",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335106403",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012303",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019380",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934060660",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282027960",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097012312",
      "ndc_label_name": "Topiramate TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048653",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205018760",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019503",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335048704",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048660",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335106402",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425021402",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027690",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865031410",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335106405",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282027910",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425021401",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027630",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789044360",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420027660",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009203",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425009201",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019502",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049501",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425049502",
      "ndc_label_name": "Topiramate Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291081790",
      "ndc_label_name": "Torsemide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111091601",
      "ndc_label_name": "Torsemide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155087201",
      "ndc_label_name": "Torsemide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722053001",
      "ndc_label_name": "Torsemide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135081990",
      "ndc_label_name": "Torsemide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407059790",
      "ndc_label_name": "Torsemide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237013901",
      "ndc_label_name": "Torsemide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268075511",
      "ndc_label_name": "Torsemide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268075515",
      "ndc_label_name": "Torsemide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189010230",
      "ndc_label_name": "Torsemide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862012601",
      "ndc_label_name": "Torsemide TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025901",
      "ndc_label_name": "Torsemide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025990",
      "ndc_label_name": "Torsemide Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111091801",
      "ndc_label_name": "Torsemide TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407059890",
      "ndc_label_name": "Torsemide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865026101",
      "ndc_label_name": "Torsemide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291081990",
      "ndc_label_name": "Torsemide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090649500",
      "ndc_label_name": "Torsemide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268075711",
      "ndc_label_name": "Torsemide TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722053201",
      "ndc_label_name": "Torsemide TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155087401",
      "ndc_label_name": "Torsemide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014101",
      "ndc_label_name": "Torsemide TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135082190",
      "ndc_label_name": "Torsemide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268075715",
      "ndc_label_name": "Torsemide TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090742500",
      "ndc_label_name": "Torsemide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862012801",
      "ndc_label_name": "Torsemide TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865026190",
      "ndc_label_name": "Torsemide Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054007725",
      "ndc_label_name": "Torsemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291081801",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904728361",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054007729",
      "ndc_label_name": "Torsemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291081850",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722053101",
      "ndc_label_name": "Torsemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237014001",
      "ndc_label_name": "Torsemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155087301",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904728306",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407036290",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090726100",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111091703",
      "ndc_label_name": "Torsemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090649900",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111091701",
      "ndc_label_name": "Torsemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266302",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291081890",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353031516",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084053901",
      "ndc_label_name": "Torsemide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135082090",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335266301",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268075615",
      "ndc_label_name": "Torsemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084053911",
      "ndc_label_name": "Torsemide TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335296201",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268075611",
      "ndc_label_name": "Torsemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335284101",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865026090",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862012701",
      "ndc_label_name": "Torsemide TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162241205",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162241201",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865026001",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162241209",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865026005",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081922",
      "ndc_label_name": "Torsemide Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722052901",
      "ndc_label_name": "Torsemide TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155087101",
      "ndc_label_name": "Torsemide Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268075411",
      "ndc_label_name": "Torsemide TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135081890",
      "ndc_label_name": "Torsemide Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50111091501",
      "ndc_label_name": "Torsemide TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291081690",
      "ndc_label_name": "Torsemide Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268075415",
      "ndc_label_name": "Torsemide TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407059690",
      "ndc_label_name": "Torsemide Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72865025890",
      "ndc_label_name": "Torsemide Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237013801",
      "ndc_label_name": "Torsemide TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862012501",
      "ndc_label_name": "Torsemide TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66215010314",
      "ndc_label_name": "Tracleer Tablet Soluble 32 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66215010356",
      "ndc_label_name": "Tracleer Tablet Soluble 32 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66215023214",
      "ndc_label_name": "Tracleer Tablet Soluble 32 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66215023256",
      "ndc_label_name": "Tracleer Tablet Soluble 32 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378415101",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440857030",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093005801",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093330101",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093330105",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378415105",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440857094",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093005805",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440857018",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440857040",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440857060",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035510",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440857006",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440857090",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634078660",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440857020",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440857091",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634078612",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808030101",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007245",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035501",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904717961",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634078671",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440857092",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634078624",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571071601",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300035505",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007246",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007265",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007267",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007228",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904749661",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634078680",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007215",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007230",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007272",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007289",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007280",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007253",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571071650",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571071610",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007224",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007285",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028330",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007298",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007290",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007254",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808030103",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "27808030102",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007240",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007294",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080600",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080602",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007292",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007260",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007220",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007250",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007257",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090300000",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080603",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080605",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080604",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007270",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007275",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028360",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028353",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090578902",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080701",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080702",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090471601",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353007273",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090471600",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028370",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080601",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013607",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090578904",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080703",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090578901",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028380",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090579001",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999012914",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090578909",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013608",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013603",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090578900",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436878702",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353028390",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013601",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090080609",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013605",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436878703",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436037701",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090578903",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436878705",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090578905",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013604",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013606",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436037706",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436878706",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436037704",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436037702",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068860",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090579002",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436037705",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068810",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407000705",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068850",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436037707",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436037708",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700041240",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090579003",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407000701",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068812",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068802",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700086401",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436878708",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436878701",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099790",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436013602",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068824",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068820",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068815",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664037708",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079099101",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079099120",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118062707",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436037703",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068840",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068830",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068818",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664037718",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52817019500",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068805",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037720",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068800",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002043230",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068884",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068821",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118062709",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700086424",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068835",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037730",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068803",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700086490",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700086430",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068828",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219234805",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700086460",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068890",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037798",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068825",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099701",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099718",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959068856",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079501",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099730",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002043220",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760077290",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118062706",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099715",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099760",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002043210",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687079511",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760031950",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700099724",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007390",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760031920",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664037713",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118062701",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700086415",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037760",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760031960",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760031909",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022982",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760058820",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118062705",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219234807",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700086418",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007384",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037709",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760031930",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022990",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760058830",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60219234801",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007382",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118062702",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919059740",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760058850",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037750",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162062711",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072709",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429058805",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022930",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118062703",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162062710",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760058890",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760037790",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056320",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072730",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760031990",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022971",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429058801",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056300",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760077220",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760058892",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404001",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072750",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760058809",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919059730",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760077250",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056350",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919059720",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007360",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404006",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072760",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760058860",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919059790",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022912",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056392",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919059772",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187006360",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871702",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072790",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760058898",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187006320",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022972",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404002",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187006315",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629489903",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871705",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072792",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072720",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187006372",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919059782",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871701",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629489901",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056315",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006620",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760077209",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072798",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187006378",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187006390",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788919909",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629489904",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056328",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205030390",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760077260",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760077230",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629489905",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629489902",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69512062710",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162062750",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084080811",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074040",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919007330",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022984",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980061450",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056399",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006672",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056345",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382031901",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335052102",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022920",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919059760",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056330",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404007",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205030372",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056391",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404003",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335052104",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022950",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919059784",
      "ndc_label_name": "TraMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056340",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788732103",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335052108",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267101800",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404008",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335052107",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022960",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187006330",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084080801",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788732105",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335251802",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404004",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404009",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335052109",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629489906",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629489909",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382031910",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788732108",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335251803",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404005",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788732102",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335131901",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980061401",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267056384",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812102",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812104",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335965804",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788732106",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788732107",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335251801",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980061410",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812103",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871703",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812109",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335965805",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812101",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788732109",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335251806",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788732101",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871704",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871706",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871708",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000640",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69150002010",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812107",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000615",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788732104",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871707",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788871709",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788919904",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000650",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006678",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812108",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000654",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812105",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788919905",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788919901",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518025802",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000653",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205030320",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006660",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000657",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788812106",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518382402",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788919906",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518359800",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039228",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205030330",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006690",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000672",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788919902",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518382405",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788919907",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518382401",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039250",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205030378",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074020",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000689",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788919903",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006630",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518382404",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205030340",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039257",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205038930",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074072",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039294",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788919908",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205030315",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093011904",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205030360",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039260",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205038960",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074078",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039820",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518025803",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205038990",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093011906",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205038972",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039265",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074030",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335052101",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086540",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093011905",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335965801",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205038915",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205038978",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039270",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335052100",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335052106",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086565",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205006640",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039224",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074090",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074015",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039290",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335052103",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149803",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086572",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205038920",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039253",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335100303",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205074060",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039880",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335052105",
      "ndc_label_name": "TraMADol HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335251809",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086575",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149804",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039273",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335251804",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149805",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086520",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335100301",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000645",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086580",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000624",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039828",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335251805",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000620",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086530",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335149807",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000646",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020501",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000630",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039890",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000665",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000667",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086553",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335965803",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000660",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005802",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000675",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086524",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000685",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000680",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086560",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000628",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000670",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015902",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000692",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086570",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039215",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039230",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020530",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000648",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000690",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015905",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000698",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086573",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039220",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039240",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420073301",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000673",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039245",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050102",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039815",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086585",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039254",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039246",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015906",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610000694",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039280",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425054808",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039865",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031190",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039267",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039854",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027405",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039846",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039285",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039867",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039873",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008005",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039272",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039872",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027607",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039853",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039840",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039875",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086550",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420012760",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039275",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086545",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425054801",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039860",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039845",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086567",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086557",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020510",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039824",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031112",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425054804",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039870",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039850",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031160",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086590",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020560",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039830",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031182",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006060",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031130",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039857",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008001",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031120",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020590",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610039885",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420020512",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031172",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031184",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086515",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420073312",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888008000",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005702",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086528",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420073330",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420073305",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420073390",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086546",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420073360",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005705",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015904",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086554",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005704",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027402",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027608",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610086592",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015903",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027603",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015907",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005701",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027401",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027606",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050103",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189031140",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050105",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425054802",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027404",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005801",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050108",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011420",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050106",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420073300",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011440",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014215",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027407",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015901",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014260",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005703",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425054803",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027403",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014290",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050101",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027601",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027406",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006030",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050104",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425054805",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027602",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027604",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425050107",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425054806",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425027605",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011430",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425054807",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014278",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011415",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011472",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011478",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011490",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804011460",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006001",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014272",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006015",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804014230",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006018",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008006090",
      "ndc_label_name": "traMADol HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862016401",
      "ndc_label_name": "Trandolapril TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440856730",
      "ndc_label_name": "Trandolapril Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005201",
      "ndc_label_name": "Trandolapril TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440856760",
      "ndc_label_name": "Trandolapril Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237008901",
      "ndc_label_name": "Trandolapril TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440856790",
      "ndc_label_name": "Trandolapril Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180056601",
      "ndc_label_name": "Trandolapril TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862016501",
      "ndc_label_name": "Trandolapril TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440856830",
      "ndc_label_name": "Trandolapril Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440856890",
      "ndc_label_name": "Trandolapril Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440856860",
      "ndc_label_name": "Trandolapril Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005301",
      "ndc_label_name": "Trandolapril TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237009001",
      "ndc_label_name": "Trandolapril TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180056701",
      "ndc_label_name": "Trandolapril TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440856930",
      "ndc_label_name": "Trandolapril Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806005401",
      "ndc_label_name": "Trandolapril TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862016601",
      "ndc_label_name": "Trandolapril TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440856960",
      "ndc_label_name": "Trandolapril Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440856990",
      "ndc_label_name": "Trandolapril Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237009101",
      "ndc_label_name": "Trandolapril TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180056801",
      "ndc_label_name": "Trandolapril TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629224701",
      "ndc_label_name": "Tranylcypromine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135073901",
      "ndc_label_name": "Tranylcypromine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429021001",
      "ndc_label_name": "Tranylcypromine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380017601",
      "ndc_label_name": "Tranylcypromine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591559001",
      "ndc_label_name": "Tranylcypromine Sulfate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980018301",
      "ndc_label_name": "Tranylcypromine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547065510",
      "ndc_label_name": "Tranylcypromine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954053810",
      "ndc_label_name": "Tranylcypromine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884003201",
      "ndc_label_name": "Tranylcypromine Sulfate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291086910",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729030001",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353040453",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353040430",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107008001",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904686961",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107008005",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440857660",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700085560",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353040480",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353065380",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353040460",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668033105",
      "ndc_label_name": "TraZODone HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291086990",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291083410",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668033101",
      "ndc_label_name": "TraZODone HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687045411",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353097415",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090252902",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959014060",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729030017",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353065330",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353065360",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291083490",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760080660",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090237300",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090672300",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489051101",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353097480",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353097430",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664002674",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353065353",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919023260",
      "ndc_label_name": "TraZODone HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090246200",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002110500",
      "ndc_label_name": "TraZODone HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760080690",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090252900",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090428300",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788713708",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353097453",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919038490",
      "ndc_label_name": "TraZODone HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090246202",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002110506",
      "ndc_label_name": "TraZODone HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187037730",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090252903",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111056101",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335073001",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090428302",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919063190",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090246203",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700073990",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980067301",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111056103",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111056102",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610051130",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090428303",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382080601",
      "ndc_label_name": "TraZODone HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090275900",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505265401",
      "ndc_label_name": "TraZODone HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335073002",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959014090",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959014030",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610051145",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664002672",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010023205",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700073930",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919023290",
      "ndc_label_name": "TraZODone HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335302202",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002110503",
      "ndc_label_name": "TraZODone HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700085530",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610051330",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664002675",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610053745",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700073960",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187013390",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789042490",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788713709",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629321004",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610053060",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60760080630",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610053780",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700085590",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629321003",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420064801",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205057490",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382080610",
      "ndc_label_name": "TraZODone HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162253101",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919023230",
      "ndc_label_name": "TraZODone HCl TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162253100",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687045401",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788713701",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420064860",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335302301",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934081730",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162253103",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629321002",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425029802",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919063130",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788713706",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420064890",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610053730",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205057430",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425029801",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980067310",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162253109",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187013330",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335302204",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980067350",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789016830",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610051360",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335304101",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788713703",
      "ndc_label_name": "TraZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610051160",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629321001",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610053053",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010023210",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610053080",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610051380",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610053753",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335302203",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610053760",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382080605",
      "ndc_label_name": "TraZODone HCl TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789042430",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610051153",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610053045",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610053030",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010023201",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789016890",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205063030",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335073005",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610051180",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162253105",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420064830",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425029803",
      "ndc_label_name": "traZODone HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268077611",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107008101",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107008105",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090612102",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904721261",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090743904",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729030101",
      "ndc_label_name": "TraZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668033205",
      "ndc_label_name": "TraZODone HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005372",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489051701",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668033201",
      "ndc_label_name": "TraZODone HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002109300",
      "ndc_label_name": "TraZODone HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729030116",
      "ndc_label_name": "TraZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959089430",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090237402",
      "ndc_label_name": "TraZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090221102",
      "ndc_label_name": "TraZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505265501",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868009",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291082950",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664005374",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291082990",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959089460",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090237404",
      "ndc_label_name": "TraZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090221104",
      "ndc_label_name": "TraZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043201",
      "ndc_label_name": "TraZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010023301",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090482504",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919047330",
      "ndc_label_name": "TraZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111045002",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700095730",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919047390",
      "ndc_label_name": "TraZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090482502",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868006",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382080705",
      "ndc_label_name": "TraZODone HCl TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090612104",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919058530",
      "ndc_label_name": "TraZODone HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002109303",
      "ndc_label_name": "TraZODone HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010023305",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382080701",
      "ndc_label_name": "TraZODone HCl TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268077615",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030201",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335208403",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090743902",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868003",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700095760",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700092130",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205081530",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335208401",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046202",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687043211",
      "ndc_label_name": "TraZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111045001",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335302401",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980067401",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980067450",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162253209",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788716603",
      "ndc_label_name": "TraZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788716601",
      "ndc_label_name": "TraZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788716606",
      "ndc_label_name": "TraZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002109306",
      "ndc_label_name": "TraZODone HCl TABLET 150 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788716609",
      "ndc_label_name": "TraZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335208402",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788868001",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919047360",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030202",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335302402",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046201",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162253205",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162253200",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425030203",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162253201",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789007930",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425046203",
      "ndc_label_name": "traZODone HCl Tablet 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353065215",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440857520",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440857590",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440857504",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353065230",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107007901",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440857530",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729029917",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353097370",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440857560",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090156101",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16729029901",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353065260",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668033001",
      "ndc_label_name": "TraZODone HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13668033005",
      "ndc_label_name": "TraZODone HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353097353",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090239306",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904686861",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959037815",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291086890",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090156100",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291083310",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291086810",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090156108",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111056003",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "13107007905",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700084460",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353065245",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090156106",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291083390",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353065253",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090237200",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919038690",
      "ndc_label_name": "TraZODone HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353097315",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919061390",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353097345",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090156109",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353065270",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353097330",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090237206",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382060910",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090237208",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382060901",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090440200",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090239308",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090239300",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090237201",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090237209",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205055130",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002113203",
      "ndc_label_name": "TraZODone HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382080505",
      "ndc_label_name": "TraZODone HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090521800",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090239309",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090239301",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090285200",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51655063452",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335157503",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002113206",
      "ndc_label_name": "TraZODone HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010023110",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090521801",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090521806",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090521808",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090660300",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959037830",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610052953",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700081060",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050530",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959037890",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700081030",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090521809",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111056001",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700084430",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610087430",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664001474",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205056830",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700081090",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934037090",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959037860",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50111056002",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664001472",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789015430",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687044311",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335070501",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "57664001475",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050590",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002113200",
      "ndc_label_name": "TraZODone HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959037820",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382080501",
      "ndc_label_name": "TraZODone HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789015460",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788711803",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335070504",
      "ndc_label_name": "TraZODone HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505265301",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205055190",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55700084490",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53489051001",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788711801",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335070502",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934011930",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610029515",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919038630",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610051430",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687044301",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118043309",
      "ndc_label_name": "TraZODone HCl TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010023101",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610051453",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934081830",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610087453",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980067250",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610052515",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919061330",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629151308",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934037030",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610052530",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934081890",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425017602",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010023105",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610052960",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187008630",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980067201",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72789015490",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425032601",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205056890",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68382080510",
      "ndc_label_name": "TraZODone HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70934011990",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425032602",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187008690",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788711806",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425032603",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425050202",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335070503",
      "ndc_label_name": "TraZODone HCl TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788711809",
      "ndc_label_name": "TraZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335157504",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610029553",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980067210",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610052560",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425050201",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610052915",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610052970",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425017601",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610052545",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "80425050203",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205050560",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610052553",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610087460",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610052570",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610029530",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610052930",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610052945",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71610087480",
      "ndc_label_name": "traZODone HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00173088710",
      "ndc_label_name": "Trelegy Ellipta Aerosol Powder Breath Activated 100-62.5-25 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173088714",
      "ndc_label_name": "Trelegy Ellipta Aerosol Powder Breath Activated 100-62.5-25 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173088761",
      "ndc_label_name": "Trelegy Ellipta Aerosol Powder Breath Activated 100-62.5-25 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173089310",
      "ndc_label_name": "Trelegy Ellipta Aerosol Powder Breath Activated 200-62.5-25 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173089361",
      "ndc_label_name": "Trelegy Ellipta Aerosol Powder Breath Activated 200-62.5-25 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173089314",
      "ndc_label_name": "Trelegy Ellipta Aerosol Powder Breath Activated 200-62.5-25 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00703068601",
      "ndc_label_name": "Treprostinil Solution 100 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781342780",
      "ndc_label_name": "Treprostinil Solution 100 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023020801",
      "ndc_label_name": "Treprostinil Solution 100 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598064711",
      "ndc_label_name": "Treprostinil Solution 100 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598064911",
      "ndc_label_name": "Treprostinil Solution 20 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023020601",
      "ndc_label_name": "Treprostinil Solution 20 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703066601",
      "ndc_label_name": "Treprostinil Solution 20 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781342080",
      "ndc_label_name": "Treprostinil Solution 20 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781343080",
      "ndc_label_name": "Treprostinil Solution 200 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703069601",
      "ndc_label_name": "Treprostinil Solution 200 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023020901",
      "ndc_label_name": "Treprostinil Solution 200 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598064811",
      "ndc_label_name": "Treprostinil Solution 200 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598064611",
      "ndc_label_name": "Treprostinil Solution 50 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42023020701",
      "ndc_label_name": "Treprostinil Solution 50 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00703067601",
      "ndc_label_name": "Treprostinil Solution 50 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00781342580",
      "ndc_label_name": "Treprostinil Solution 50 MG/20ML Injection",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291087001",
      "ndc_label_name": "Tretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904686704",
      "ndc_label_name": "Tretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162122003",
      "ndc_label_name": "Tretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629875201",
      "ndc_label_name": "Tretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629228501",
      "ndc_label_name": "Tretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555080802",
      "ndc_label_name": "Tretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904686760",
      "ndc_label_name": "Tretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291084301",
      "ndc_label_name": "Tretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084007511",
      "ndc_label_name": "Tretinoin CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162122001",
      "ndc_label_name": "Tretinoin Capsule 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10370026801",
      "ndc_label_name": "Tretinoin CAPSULE 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084007521",
      "ndc_label_name": "Tretinoin CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462079201",
      "ndc_label_name": "Tretinoin CAPSULE 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00472011720",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378808220",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118003502",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714027001",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00472011745",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672140700",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574222520",
      "ndc_label_name": "Tretinoin CREAM 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213502",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574222545",
      "ndc_label_name": "Tretinoin CREAM 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378808245",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788406902",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714027002",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090312800",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922007906",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922007925",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788885702",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090717100",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332080945",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090065100",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162213504",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672140709",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332080920",
      "ndc_label_name": "Tretinoin Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378808320",
      "ndc_label_name": "Tretinoin Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714024901",
      "ndc_label_name": "Tretinoin Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090681900",
      "ndc_label_name": "Tretinoin Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378808345",
      "ndc_label_name": "Tretinoin Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672139400",
      "ndc_label_name": "Tretinoin Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672139409",
      "ndc_label_name": "Tretinoin Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574220520",
      "ndc_label_name": "Tretinoin CREAM 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090305800",
      "ndc_label_name": "Tretinoin Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714024902",
      "ndc_label_name": "Tretinoin Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574220545",
      "ndc_label_name": "Tretinoin CREAM 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959093420",
      "ndc_label_name": "Tretinoin Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162215802",
      "ndc_label_name": "Tretinoin Cream 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090309000",
      "ndc_label_name": "Tretinoin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574220145",
      "ndc_label_name": "Tretinoin CREAM 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378808445",
      "ndc_label_name": "Tretinoin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378808420",
      "ndc_label_name": "Tretinoin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578015309",
      "ndc_label_name": "Tretinoin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090434700",
      "ndc_label_name": "Tretinoin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574220120",
      "ndc_label_name": "Tretinoin CREAM 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714025001",
      "ndc_label_name": "Tretinoin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578015308",
      "ndc_label_name": "Tretinoin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714025002",
      "ndc_label_name": "Tretinoin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332080720",
      "ndc_label_name": "Tretinoin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959093320",
      "ndc_label_name": "Tretinoin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332080745",
      "ndc_label_name": "Tretinoin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090448600",
      "ndc_label_name": "Tretinoin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672139500",
      "ndc_label_name": "Tretinoin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672139509",
      "ndc_label_name": "Tretinoin Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378808545",
      "ndc_label_name": "Tretinoin Gel 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574230145",
      "ndc_label_name": "Tretinoin GEL 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922005606",
      "ndc_label_name": "Tretinoin Gel 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651071246",
      "ndc_label_name": "Tretinoin Gel 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922005604",
      "ndc_label_name": "Tretinoin Gel 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378808515",
      "ndc_label_name": "Tretinoin Gel 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162107102",
      "ndc_label_name": "Tretinoin Gel 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335295201",
      "ndc_label_name": "Tretinoin Gel 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651071214",
      "ndc_label_name": "Tretinoin Gel 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574230115",
      "ndc_label_name": "Tretinoin GEL 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629912301",
      "ndc_label_name": "Tretinoin Gel 0.01 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574232515",
      "ndc_label_name": "Tretinoin GEL 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378808615",
      "ndc_label_name": "Tretinoin Gel 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629912401",
      "ndc_label_name": "Tretinoin Gel 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378808645",
      "ndc_label_name": "Tretinoin Gel 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162107202",
      "ndc_label_name": "Tretinoin Gel 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922005704",
      "ndc_label_name": "Tretinoin Gel 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335289801",
      "ndc_label_name": "Tretinoin Gel 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574232545",
      "ndc_label_name": "Tretinoin GEL 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "21922005706",
      "ndc_label_name": "Tretinoin Gel 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651071314",
      "ndc_label_name": "Tretinoin Gel 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651071346",
      "ndc_label_name": "Tretinoin Gel 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68682080045",
      "ndc_label_name": "Tretinoin GEL 0.05 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378809045",
      "ndc_label_name": "Tretinoin Gel 0.05 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00093214062",
      "ndc_label_name": "Tri-Lo-Sprintec TABLET 0.18/0.215/0.25 MG-25 MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093214028",
      "ndc_label_name": "Tri-Lo-Sprintec TABLET 0.18/0.215/0.25 MG-25 MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788703602",
      "ndc_label_name": "Tri-Lo-Sprintec Tablet 0.18/0.215/0.25 MG-25 MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090232600",
      "ndc_label_name": "Tri-Lo-Sprintec Tablet 0.18/0.215/0.25 MG-25 MCG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "20254020401",
      "ndc_label_name": "Tri-Pseudaphed TABLET 2.5-60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00087040303",
      "ndc_label_name": "Tri-Vi-Sol A/C/D Solution 250-50-10 Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00087040365",
      "ndc_label_name": "Tri-Vi-Sol A/C/D Solution 250-50-10 Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959024250",
      "ndc_label_name": "Tri-Vitamin/Fluoride Solution 0.25 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959096750",
      "ndc_label_name": "Tri-Vitamin/Fluoride Solution 0.25 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71399750405",
      "ndc_label_name": "Tri-Vite Pediatric Solution 750-400-35 UNIT-MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162165902",
      "ndc_label_name": "Tri-Vite/Fluoride Solution 0.5 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629114101",
      "ndc_label_name": "Tri-Vite/Fluoride Solution 0.5 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58657032450",
      "ndc_label_name": "Tri-Vite/Fluoride Solution 0.5 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "45802010901",
      "ndc_label_name": "Triamcinolone Acetonide Aerosol 55 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "60505627507",
      "ndc_label_name": "Triamcinolone Acetonide Aerosol 55 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "72162228902",
      "ndc_label_name": "Triamcinolone Acetonide Aerosol 55 MCG/ACT Nasal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00440031715",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714098502",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713022615",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168000380",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090265800",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440031745",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168000315",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802006305",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440031780",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342032780",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335287001",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999014980",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877031715",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802006336",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713022680",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802006335",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714098501",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629878401",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788750108",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090194901",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342032715",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090029301",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629878201",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877031745",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629878301",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788704808",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877031780",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090370400",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162183502",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090232001",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788851508",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788889901",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959019901",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959019903",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788704801",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162233402",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162183504",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162233404",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713022515",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713022531",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168000416",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440025115",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168000480",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714098603",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168000415",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21922006205",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21922006230",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802006435",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440025130",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714098602",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440025180",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21922006204",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714098601",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342032915",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52817081154",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090654700",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440025145",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802006436",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21922006215",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090065000",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714098604",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342032980",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002093387",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919023430",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713022580",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090016200",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187087015",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919023415",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342032954",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802006405",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919065015",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629877801",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090144500",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672128202",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877025130",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877025115",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999015015",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959009680",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187005315",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629877901",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090210600",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959009601",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788835001",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335271201",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090022800",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002093363",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629845601",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267093430",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672128201",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919023480",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788835008",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189033080",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090656600",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919059415",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788835600",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162183203",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118998305",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629878001",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788875301",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187002515",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50436084301",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788835603",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205062715",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629878101",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118998404",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788835608",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189057180",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788875308",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672128208",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205012415",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71656004215",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788917201",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63187087080",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335221101",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162138604",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205012480",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959009600",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71656004280",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189003980",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72189027715",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877025145",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804014530",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959009603",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788875303",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959009645",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335271301",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "66267093380",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71656004230",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877025180",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83008008830",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "76420020315",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804007130",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002097763",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877031815",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788889201",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342032815",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168000215",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00440031815",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714098701",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205000915",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788845701",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71335271401",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162138702",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802006535",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090653300",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162183602",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49999028515",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788750601",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959013600",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090254200",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629870701",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118998205",
      "ndc_label_name": "Triamcinolone Acetonide CREAM 0.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629878501",
      "ndc_label_name": "Triamcinolone Acetonide Cream 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168033660",
      "ndc_label_name": "Triamcinolone Acetonide Lotion 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70752012905",
      "ndc_label_name": "Triamcinolone Acetonide Lotion 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432056061",
      "ndc_label_name": "Triamcinolone Acetonide Lotion 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432056060",
      "ndc_label_name": "Triamcinolone Acetonide Lotion 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162206906",
      "ndc_label_name": "Triamcinolone Acetonide Lotion 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71656004060",
      "ndc_label_name": "Triamcinolone Acetonide Lotion 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168033760",
      "ndc_label_name": "Triamcinolone Acetonide Lotion 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713067653",
      "ndc_label_name": "Triamcinolone Acetonide LOTION 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42571038519",
      "ndc_label_name": "Triamcinolone Acetonide Lotion 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432056160",
      "ndc_label_name": "Triamcinolone Acetonide Lotion 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60432056161",
      "ndc_label_name": "Triamcinolone Acetonide Lotion 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70752013005",
      "ndc_label_name": "Triamcinolone Acetonide Lotion 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118998006",
      "ndc_label_name": "Triamcinolone Acetonide LOTION 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162207006",
      "ndc_label_name": "Triamcinolone Acetonide Lotion 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714026702",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168000580",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713022915",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714026703",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342033115",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713022980",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342033154",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802005436",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162233504",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342033180",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714026701",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090380200",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802005405",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802005435",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.025 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090036200",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162233502",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629884101",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.025 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21922006330",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168000680",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713022831",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168000616",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21922006304",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00168000615",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713022815",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342033354",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090224400",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090697800",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714027603",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714027602",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090250600",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713022880",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090016300",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342033380",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090338000",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58118998108",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090767900",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21922006305",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002091287",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714027601",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090379700",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802005535",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090350800",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205003315",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672128402",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802005505",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959015602",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "21922006315",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672128401",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802005536",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205010880",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342033315",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672128408",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090476100",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804007930",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959015601",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61919061915",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959015600",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205010815",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "53002091263",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.1 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162233604",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162233602",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.1 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714026801",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462079817",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090598000",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "82804001915",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713067915",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090621100",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342033215",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71205003815",
      "ndc_label_name": "Triamcinolone Acetonide Ointment 0.5 % External",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "45802004935",
      "ndc_label_name": "Triamcinolone Acetonide OINTMENT 0.5 % EXTERNAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713065540",
      "ndc_label_name": "Triamcinolone Acetonide PASTE 0.1 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35356008801",
      "ndc_label_name": "Triamcinolone Acetonide Paste 0.1 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51672126705",
      "ndc_label_name": "Triamcinolone Acetonide PASTE 0.1 % MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00713076640",
      "ndc_label_name": "Triamcinolone Acetonide Paste 0.1 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "35573040454",
      "ndc_label_name": "Triamcinolone Acetonide Paste 0.1 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788838605",
      "ndc_label_name": "Triamcinolone Acetonide Paste 0.1 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090044500",
      "ndc_label_name": "Triamcinolone Acetonide Paste 0.1 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70752014017",
      "ndc_label_name": "Triamcinolone Acetonide Paste 0.1 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64980032005",
      "ndc_label_name": "Triamcinolone Acetonide PASTE 0.1 % MOUTH/THROAT",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162231802",
      "ndc_label_name": "Triamcinolone Acetonide Paste 0.1 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788781405",
      "ndc_label_name": "Triamcinolone Acetonide Paste 0.1 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68788884105",
      "ndc_label_name": "Triamcinolone Acetonide Paste 0.1 % Mouth/Throat",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452790002",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779001103",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779001101",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779001105",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452790003",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779001104",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552003304",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552003303",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552003302",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452790004",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552003301",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779001106",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452790006",
      "ndc_label_name": "Triamcinolone Acetonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "38779001109",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307052005",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991115602",
      "ndc_label_name": "Triamcinolone Acetonide Powder",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51552003305",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991115601",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51927132600",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49452790001",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307052001",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991115603",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63307052011",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991115604",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "62991115605",
      "ndc_label_name": "Triamcinolone Acetonide POWDER",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090743700",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135058101",
      "ndc_label_name": "Triamterene-HCTZ CAPSULE 37.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527163201",
      "ndc_label_name": "Triamterene-HCTZ CAPSULE 37.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527163210",
      "ndc_label_name": "Triamterene-HCTZ CAPSULE 37.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378253701",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781207401",
      "ndc_label_name": "Triamterene-HCTZ CAPSULE 37.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378253710",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291084110",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090743800",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356097490",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090052301",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135058110",
      "ndc_label_name": "Triamterene-HCTZ CAPSULE 37.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071230",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090694400",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781207410",
      "ndc_label_name": "Triamterene-HCTZ CAPSULE 37.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090052300",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071290",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090202804",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071200",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090743704",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002124600",
      "ndc_label_name": "Triamterene-HCTZ CAPSULE 37.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629150701",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090052304",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002124603",
      "ndc_label_name": "Triamterene-HCTZ CAPSULE 37.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187090530",
      "ndc_label_name": "Triamterene-HCTZ CAPSULE 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760053590",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760078390",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578009010",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629150702",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870003",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090202800",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629150703",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187090590",
      "ndc_label_name": "Triamterene-HCTZ CAPSULE 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870006",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135052990",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629873201",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629150704",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870009",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090202801",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870001",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335050403",
      "ndc_label_name": "Triamterene-HCTZ CAPSULE 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335050401",
      "ndc_label_name": "Triamterene-HCTZ CAPSULE 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090743701",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578009001",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959071215",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335050402",
      "ndc_label_name": "Triamterene-HCTZ CAPSULE 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335050404",
      "ndc_label_name": "Triamterene-HCTZ CAPSULE 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162108406",
      "ndc_label_name": "Triamterene-HCTZ Capsule 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090127001",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591042405",
      "ndc_label_name": "Triamterene-HCTZ TABLET 37.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440857890",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440857930",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610060260",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090127100",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440857830",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378135205",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090127101",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090580102",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440857990",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063042490",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018390",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090580101",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591042401",
      "ndc_label_name": "Triamterene-HCTZ TABLET 37.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291084250",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289009030",
      "ndc_label_name": "Triamterene-HCTZ TABLET 37.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289009090",
      "ndc_label_name": "Triamterene-HCTZ TABLET 37.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090127102",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090127000",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919033830",
      "ndc_label_name": "Triamterene-HCTZ TABLET 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407028601",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090127002",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090580100",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544040845",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700039430",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959097730",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382085601",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544040874",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544040860",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289009015",
      "ndc_label_name": "Triamterene-HCTZ TABLET 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407028605",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084075095",
      "ndc_label_name": "Triamterene-HCTZ TABLET 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700039490",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752603",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752606",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505265605",
      "ndc_label_name": "Triamterene-HCTZ TABLET 37.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001032700",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752609",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505265601",
      "ndc_label_name": "Triamterene-HCTZ TABLET 37.5-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544040830",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919030490",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001032703",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610068460",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789309",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789301",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934015930",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382085605",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610060560",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084075025",
      "ndc_label_name": "Triamterene-HCTZ TABLET 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888009405",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789303",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788752601",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789306",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789018330",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888009401",
      "ndc_label_name": "Triamterene-HCTZ Tablet 37.5-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591034805",
      "ndc_label_name": "Triamterene-HCTZ TABLET 75-50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440858530",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440858515",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378135501",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378135505",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591034801",
      "ndc_label_name": "Triamterene-HCTZ TABLET 75-50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090310602",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440858510",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591034810",
      "ndc_label_name": "Triamterene-HCTZ TABLET 75-50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090310600",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440858590",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440858545",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999009400",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090037202",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090310605",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090037200",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505265705",
      "ndc_label_name": "Triamterene-HCTZ TABLET 75-50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090673600",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090673602",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090183400",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090183405",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090037205",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848403",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048815",
      "ndc_label_name": "Triamterene-HCTZ TABLET 75-50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544010230",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090673605",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048890",
      "ndc_label_name": "Triamterene-HCTZ TABLET 75-50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629258501",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048830",
      "ndc_label_name": "Triamterene-HCTZ TABLET 75-50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090183402",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862409",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505265701",
      "ndc_label_name": "Triamterene-HCTZ TABLET 75-50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848401",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289048801",
      "ndc_label_name": "Triamterene-HCTZ TABLET 75-50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544010251",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382085705",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544010245",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888009501",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888009505",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544010260",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848406",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001032800",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853901",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853903",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862401",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001032803",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853906",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382085701",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848409",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788853909",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043145",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862403",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610043160",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788862406",
      "ndc_label_name": "Triamterene-HCTZ Tablet 75-50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742064501",
      "ndc_label_name": "Triazolam Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054485825",
      "ndc_label_name": "Triazolam Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289079002",
      "ndc_label_name": "Triazolam Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762371709",
      "ndc_label_name": "Triazolam Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710152101",
      "ndc_label_name": "Triazolam Tablet 0.125 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054485929",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054485925",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353045130",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356065730",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099602",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090778700",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999005510",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353045153",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710128901",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289078702",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999005501",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063099630",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090052201",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040230",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999005560",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040201",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090647101",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289078730",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090778701",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090052200",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762371803",
      "ndc_label_name": "Triazolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040260",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762371809",
      "ndc_label_name": "Triazolam TABLET 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040210",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700096030",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267049230",
      "ndc_label_name": "Triazolam TABLET 0.25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789034930",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090647100",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710128905",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436371801",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50742064601",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959040250",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289078760",
      "ndc_label_name": "Triazolam Tablet 0.25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162220401",
      "ndc_label_name": "Trifluoperazine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378240101",
      "ndc_label_name": "Trifluoperazine HCl TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781802801",
      "ndc_label_name": "Trifluoperazine HCl Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079057201",
      "ndc_label_name": "Trifluoperazine HCl TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079057220",
      "ndc_label_name": "Trifluoperazine HCl TABLET 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079057501",
      "ndc_label_name": "Trifluoperazine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781803601",
      "ndc_label_name": "Trifluoperazine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162220501",
      "ndc_label_name": "Trifluoperazine HCl Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378241001",
      "ndc_label_name": "Trifluoperazine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079057520",
      "ndc_label_name": "Trifluoperazine HCl TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079057320",
      "ndc_label_name": "Trifluoperazine HCl TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781803201",
      "ndc_label_name": "Trifluoperazine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378240201",
      "ndc_label_name": "Trifluoperazine HCl TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071080730",
      "ndc_label_name": "Trifluoperazine HCl TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079057301",
      "ndc_label_name": "Trifluoperazine HCl TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162220601",
      "ndc_label_name": "Trifluoperazine HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378240501",
      "ndc_label_name": "Trifluoperazine HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079057401",
      "ndc_label_name": "Trifluoperazine HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781803401",
      "ndc_label_name": "Trifluoperazine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162220701",
      "ndc_label_name": "Trifluoperazine HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079057420",
      "ndc_label_name": "Trifluoperazine HCl TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61314004475",
      "ndc_label_name": "Trifluridine Solution 1 % Ophthalmic",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121065816",
      "ndc_label_name": "Trihexyphenidyl HCl Solution 0.4 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70954021220",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571016011",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452024132",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090299400",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591533501",
      "ndc_label_name": "Trihexyphenidyl HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452024120",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591533510",
      "ndc_label_name": "Trihexyphenidyl HCl TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407026501",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571016010",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954021210",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407026510",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591533701",
      "ndc_label_name": "Trihexyphenidyl HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571016111",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16571016110",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591533710",
      "ndc_label_name": "Trihexyphenidyl HCl TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452024220",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090278400",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452024232",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407026601",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954021120",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407026610",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954021110",
      "ndc_label_name": "Trihexyphenidyl HCl Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51167033101",
      "ndc_label_name": "Trikafta Tablet Therapy Pack 100-50-75 & 150 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51167010602",
      "ndc_label_name": "Trikafta Tablet Therapy Pack 50-25-37.5 & 75 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51862048601",
      "ndc_label_name": "Trimethoprim Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407025701",
      "ndc_label_name": "Trimethoprim Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440859220",
      "ndc_label_name": "Trimethoprim Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75907004301",
      "ndc_label_name": "Trimethoprim Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407073801",
      "ndc_label_name": "Trimethoprim Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70954054110",
      "ndc_label_name": "Trimethoprim Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811000710",
      "ndc_label_name": "Trinatal Rx 1 Tablet 60-1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13811052501",
      "ndc_label_name": "Triphrocaps Capsule 1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904880531",
      "ndc_label_name": "Triple Antibiotic Ointment External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090725900",
      "ndc_label_name": "Triple Antibiotic Ointment External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904880567",
      "ndc_label_name": "Triple Antibiotic Ointment External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61269017956",
      "ndc_label_name": "Triple Antibiotic Ointment External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896014309",
      "ndc_label_name": "Triple Antibiotic Ointment External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11527016247",
      "ndc_label_name": "Triple Antibiotic Ointment External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000009401",
      "ndc_label_name": "Triple Antibiotic Ointment External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "71205060028",
      "ndc_label_name": "Triple Antibiotic Ointment External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896014314",
      "ndc_label_name": "Triple Antibiotic Ointment External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917019006",
      "ndc_label_name": "Triple Antibiotic Ointment External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70000005801",
      "ndc_label_name": "Triple Antibiotic Ointment External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61269017934",
      "ndc_label_name": "Triple Antibiotic Ointment External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917016332",
      "ndc_label_name": "Triple Antibiotic Pain Relief OINTMENT 1 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "51824007401",
      "ndc_label_name": "Triple Antibiotic Pain Relief Ointment 1 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917016411",
      "ndc_label_name": "Triple Antibiotic Pain Relief OINTMENT 1 % EXTERNAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49702025837",
      "ndc_label_name": "Triumeq PD Tablet Soluble 60-5-30 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49702027259",
      "ndc_label_name": "Triumeq PD Tablet Soluble 60-5-30 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49702023113",
      "ndc_label_name": "Triumeq TABLET 600-50-300 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090160600",
      "ndc_label_name": "Triumeq Tablet 600-50-300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356011660",
      "ndc_label_name": "Trizivir Tablet 300-150-300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356011606",
      "ndc_label_name": "Trizivir Tablet 300-150-300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49702021718",
      "ndc_label_name": "Trizivir Tablet 300-150-300 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904705952",
      "ndc_label_name": "Trospium Chloride Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155053006",
      "ndc_label_name": "Trospium Chloride TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462046110",
      "ndc_label_name": "Trospium Chloride Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335296101",
      "ndc_label_name": "Trospium Chloride Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162110806",
      "ndc_label_name": "Trospium Chloride Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629845701",
      "ndc_label_name": "Trospium Chloride Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574014560",
      "ndc_label_name": "Trospium Chloride TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155053005",
      "ndc_label_name": "Trospium Chloride TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097091203",
      "ndc_label_name": "Trospium Chloride TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610081287",
      "ndc_label_name": "Trospium Chloride Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462046160",
      "ndc_label_name": "Trospium Chloride TABLET 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342055409",
      "ndc_label_name": "Trospium Chloride Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789034860",
      "ndc_label_name": "Trospium Chloride Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135074260",
      "ndc_label_name": "Trospium Chloride Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282033660",
      "ndc_label_name": "Trospium Chloride TABLET 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629927901",
      "ndc_label_name": "Trospium Chloride Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "90096014160",
      "ndc_label_name": "Trospium Chloride Tablet 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "56151149403",
      "ndc_label_name": "True Metrix Air Glucose Meter Kit w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151149002",
      "ndc_label_name": "True Metrix Air Glucose Meter KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917017389",
      "ndc_label_name": "True Metrix Air Glucose Meter KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151146004",
      "ndc_label_name": "True Metrix Blood Glucose Test STRIP IN VITRO",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151146001",
      "ndc_label_name": "True Metrix Blood Glucose Test Strip In Vitro",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917016689",
      "ndc_label_name": "True Metrix Meter KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151147004",
      "ndc_label_name": "True Metrix Meter Kit w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090558400",
      "ndc_label_name": "True Metrix Meter Kit w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090558401",
      "ndc_label_name": "True Metrix Meter Kit w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151147002",
      "ndc_label_name": "True Metrix Meter KIT w/Device",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151211001",
      "ndc_label_name": "TRUEplus 5-Bevel Pen Needles 29G X 12.7MM",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151211101",
      "ndc_label_name": "TRUEplus 5-Bevel Pen Needles 31G X 5 MM",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151211201",
      "ndc_label_name": "TRUEplus 5-Bevel Pen Needles 31G X 6 MM",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151211301",
      "ndc_label_name": "TRUEplus 5-Bevel Pen Needles 31G X 8 MM",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151211401",
      "ndc_label_name": "TRUEplus 5-Bevel Pen Needles 32G X 4 MM",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151170201",
      "ndc_label_name": "TRUEplus Insulin Syringe 28G X 1/2\" 0.5 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151170301",
      "ndc_label_name": "TRUEplus Insulin Syringe 28G X 1/2\" 1 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151171101",
      "ndc_label_name": "TRUEplus Insulin Syringe 29G X 1/2\" 0.3 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151171201",
      "ndc_label_name": "TRUEplus Insulin Syringe 29G X 1/2\" 0.5 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151171301",
      "ndc_label_name": "TRUEplus Insulin Syringe 29G X 1/2\" 1 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151172101",
      "ndc_label_name": "TRUEplus Insulin Syringe 30G X 5/16\" 0.3 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151172201",
      "ndc_label_name": "TRUEplus Insulin Syringe 30G X 5/16\" 0.5 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151172301",
      "ndc_label_name": "TRUEplus Insulin Syringe 30G X 5/16\" 1 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151173101",
      "ndc_label_name": "TRUEplus Insulin Syringe 31G X 5/16\" 0.3 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151173201",
      "ndc_label_name": "TRUEplus Insulin Syringe 31G X 5/16\" 0.5 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151173301",
      "ndc_label_name": "TRUEplus Insulin Syringe 31G X 5/16\" 1 ML",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "56151014101",
      "ndc_label_name": "TRUEplus Lancets 26G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013416",
      "ndc_label_name": "TRUEplus Lancets 28G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013415",
      "ndc_label_name": "TRUEplus Lancets 28G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151014260",
      "ndc_label_name": "TRUEplus Lancets 28G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151014401",
      "ndc_label_name": "TRUEplus Lancets 30G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151014801",
      "ndc_label_name": "TRUEplus Lancets 30G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013417",
      "ndc_label_name": "TRUEplus Lancets 30G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151014402",
      "ndc_label_name": "TRUEplus Lancets 30G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090355801",
      "ndc_label_name": "TRUEplus Lancets 33G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917013418",
      "ndc_label_name": "TRUEplus Lancets 33G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090715900",
      "ndc_label_name": "TRUEplus Lancets 33G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "56151014701",
      "ndc_label_name": "TRUEplus Lancets 33G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090355800",
      "ndc_label_name": "TRUEplus Lancets 33G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50090715901",
      "ndc_label_name": "TRUEplus Lancets 33G",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "05632083060",
      "ndc_label_name": "Trustex Lub/Ribbed/Studded",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "05632083065",
      "ndc_label_name": "Trustex Lub/Ribbed/Studded",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "05632083137",
      "ndc_label_name": "Trustex Lubricated Ex Large",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "05632083157",
      "ndc_label_name": "Trustex Lubricated Ex Large",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "05632083045",
      "ndc_label_name": "Trustex Ria Lubricated",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "05632083040",
      "ndc_label_name": "Trustex Ria Lubricated",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "05632083025",
      "ndc_label_name": "Trustex Ria Lubricated",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "05632083020",
      "ndc_label_name": "Trustex Ria Lubricated",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "05632083055",
      "ndc_label_name": "Trustex Ria Non-Lubricated",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "05632083050",
      "ndc_label_name": "Trustex Ria Non-Lubricated",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61958070301",
      "ndc_label_name": "Truvada Tablet 100-150 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958070401",
      "ndc_label_name": "Truvada Tablet 133-200 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958070501",
      "ndc_label_name": "Truvada Tablet 167-250 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "04351096510",
      "ndc_label_name": "TruZone Peak Flow Meter DEVICE",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83490044070",
      "ndc_label_name": "Tubing/Wing Tip",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090164500",
      "ndc_label_name": "Twinrix Suspension Prefilled Syringe 720-20 ELU-MCG/ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160081552",
      "ndc_label_name": "Twinrix Suspension Prefilled Syringe 720-20 ELU-MCG/ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "58160081543",
      "ndc_label_name": "Twinrix Suspension Prefilled Syringe 720-20 ELU-MCG/ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61958140101",
      "ndc_label_name": "Tybost Tablet 150 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70539000102",
      "ndc_label_name": "Tymlos Solution Pen-injector 3120 MCG/1.56ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70539000101",
      "ndc_label_name": "Tymlos Solution Pen-injector 3120 MCG/1.56ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50027049460",
      "ndc_label_name": "Ultra Neb Accessories Kit",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66993013497",
      "ndc_label_name": "Umeclidinium-Vilanterol Aerosol Powder Breath Activated 62.5-25 MCG/ACT Inhalation",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "46017004408",
      "ndc_label_name": "Unifiber POWDER ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "66215061006",
      "ndc_label_name": "Uptravi TABLET 1000 MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66215061206",
      "ndc_label_name": "Uptravi TABLET 1200 MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66215061406",
      "ndc_label_name": "Uptravi TABLET 1400 MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66215061606",
      "ndc_label_name": "Uptravi TABLET 1600 MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66215060214",
      "ndc_label_name": "Uptravi TABLET 200 MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66215060206",
      "ndc_label_name": "Uptravi TABLET 200 MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66215060406",
      "ndc_label_name": "Uptravi TABLET 400 MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66215060606",
      "ndc_label_name": "Uptravi TABLET 600 MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66215060806",
      "ndc_label_name": "Uptravi TABLET 800 MCG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378173001",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806050301",
      "ndc_label_name": "Ursodiol CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527132601",
      "ndc_label_name": "Ursodiol CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904716806",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "24658078001",
      "ndc_label_name": "Ursodiol CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291092301",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10702023701",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591315901",
      "ndc_label_name": "Ursodiol CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904622161",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087193",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904622106",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904716861",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268079715",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087101",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380084406",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135054301",
      "ndc_label_name": "Ursodiol CAPSULE 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429066201",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268079711",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42385094601",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162198801",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72664021701",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063087160",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079038301",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51224015150",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603061301",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162156301",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079038320",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687010001",
      "ndc_label_name": "Ursodiol CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407075401",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687010011",
      "ndc_label_name": "Ursodiol CAPSULE 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651042101",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135043060",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629117301",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629104801",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238154001",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162216801",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710148301",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789020501",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930001512",
      "ndc_label_name": "Ursodiol Capsule 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904689004",
      "ndc_label_name": "Ursodiol Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052711",
      "ndc_label_name": "Ursodiol Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462047301",
      "ndc_label_name": "Ursodiol TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380091806",
      "ndc_label_name": "Ursodiol Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162150001",
      "ndc_label_name": "Ursodiol Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884041201",
      "ndc_label_name": "Ursodiol TABLET 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591299801",
      "ndc_label_name": "Ursodiol Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687052721",
      "ndc_label_name": "Ursodiol Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001037700",
      "ndc_label_name": "Ursodiol Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629228601",
      "ndc_label_name": "Ursodiol Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710112701",
      "ndc_label_name": "Ursodiol Tablet 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629228701",
      "ndc_label_name": "Ursodiol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001037800",
      "ndc_label_name": "Ursodiol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49884041301",
      "ndc_label_name": "Ursodiol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591300501",
      "ndc_label_name": "Ursodiol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380091906",
      "ndc_label_name": "Ursodiol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291093101",
      "ndc_label_name": "Ursodiol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710112801",
      "ndc_label_name": "Ursodiol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162150101",
      "ndc_label_name": "Ursodiol Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462047401",
      "ndc_label_name": "Ursodiol TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063077120",
      "ndc_label_name": "ValACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378427693",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714069703",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781520931",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063077114",
      "ndc_label_name": "ValACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070530",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070590",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378427677",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090222303",
      "ndc_label_name": "ValACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714069701",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090210100",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781520992",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090117300",
      "ndc_label_name": "ValACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090117303",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063077106",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090117302",
      "ndc_label_name": "ValACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090257502",
      "ndc_label_name": "ValACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090210102",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090210101",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070505",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727001",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727002",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063077121",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090222301",
      "ndc_label_name": "ValACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002000609",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343005230",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090222300",
      "ndc_label_name": "ValACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090117301",
      "ndc_label_name": "ValACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077630",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51660090530",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090210103",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268078915",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919091930",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002000606",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090257503",
      "ndc_label_name": "ValACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090257500",
      "ndc_label_name": "ValACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077690",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959030321",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090222302",
      "ndc_label_name": "ValACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010890",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135061430",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002000610",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268078911",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090257501",
      "ndc_label_name": "ValACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304090590",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746032537",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090388001",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343005290",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077620",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746032590",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077604",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727000",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335253401",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760046942",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090748400",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746032530",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788634502",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760075742",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077614",
      "ndc_label_name": "ValACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090727003",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189059416",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919091921",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010830",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077610",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788634504",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084030911",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187095020",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002000601",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009004190",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187095004",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002000603",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187077621",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788634507",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788634500",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187095021",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002000620",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804009321",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187095030",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002000604",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304090530",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870502",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788634503",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870500",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700091321",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804009330",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862044990",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002000621",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788634501",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335063001",
      "ndc_label_name": "ValACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870503",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870507",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237004330",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189005130",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084030921",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135061490",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870501",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804000610",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882005",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882001",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237004390",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367026309",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870505",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882002",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788870504",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367026330",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015405",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335253402",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919091904",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934038530",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882000",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003721",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882003",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189059404",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015412",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003760",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187095010",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804009310",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003790",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804000621",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882004",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189005121",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862044930",
      "ndc_label_name": "ValACYclovir HCl TABLET 1 GM ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189059421",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788882007",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189059430",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015402",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189003730",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789045221",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804000630",
      "ndc_label_name": "valACYclovir HCl Tablet 1 GM Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378427593",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714069801",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073090",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378427577",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714069803",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073010",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904656507",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781520892",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781520831",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070430",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063077814",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353088399",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090173500",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063077810",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063077890",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722070490",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904656561",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353088383",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353080699",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237004230",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251001",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090173502",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090222400",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251002",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063073014",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090173501",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002078312",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084021521",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090658100",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090222401",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090222403",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079009301",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090173503",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251000",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002078320",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015302",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090770200",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090585200",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090585202",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010730",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090222402",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251003",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135061390",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015305",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746032430",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090585203",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090658101",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407010790",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090585201",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090658102",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781803",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804000930",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746032490",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090658103",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343005130",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002078306",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090691800",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746032437",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367026230",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804021210",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006660",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268078811",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343005190",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002078310",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268078815",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919006620",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026390",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919051520",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304090490",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51079009303",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187083210",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135061330",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002078330",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862044890",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009004090",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934010614",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084021501",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51660090430",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187083230",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335002106",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002078340",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848203",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63304090430",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189063030",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788637900",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118090403",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739007710",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026328",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237004290",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026314",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739052510",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084021511",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788890403",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026430",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862044830",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788781809",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118090409",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825109",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788848209",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69367026209",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097015312",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934038730",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026310",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335070806",
      "ndc_label_name": "ValACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187083206",
      "ndc_label_name": "ValACYclovir HCl TABLET 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189063020",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009004030",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789026306",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804000906",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804021230",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804021206",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788825103",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788890409",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162236609",
      "ndc_label_name": "valACYclovir HCl Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921021012",
      "ndc_label_name": "valGANciclovir HCl Solution Reconstituted 50 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687076513",
      "ndc_label_name": "valGANciclovir HCl Solution Reconstituted 50 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "59651044401",
      "ndc_label_name": "valGANciclovir HCl Solution Reconstituted 50 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291097201",
      "ndc_label_name": "valGANciclovir HCl Solution Reconstituted 50 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72205001901",
      "ndc_label_name": "valGANciclovir HCl Solution Reconstituted 50 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00591257920",
      "ndc_label_name": "ValGANciclovir HCl SOLUTION RECONSTITUTED 50 MG/ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904741904",
      "ndc_label_name": "valGANciclovir HCl Solution Reconstituted 50 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603017401",
      "ndc_label_name": "valGANciclovir HCl Solution Reconstituted 50 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241015919",
      "ndc_label_name": "ValGANciclovir HCl Solution Reconstituted 50 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70010005140",
      "ndc_label_name": "valGANciclovir HCl Solution Reconstituted 50 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722083710",
      "ndc_label_name": "valGANciclovir HCl Solution Reconstituted 50 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70069081001",
      "ndc_label_name": "valGANciclovir HCl Solution Reconstituted 50 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63629228801",
      "ndc_label_name": "valGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60429084660",
      "ndc_label_name": "ValGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "16714076501",
      "ndc_label_name": "valGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291087560",
      "ndc_label_name": "valGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084096519",
      "ndc_label_name": "valGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00603633020",
      "ndc_label_name": "valGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904679604",
      "ndc_label_name": "ValGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291097360",
      "ndc_label_name": "valGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "65862075360",
      "ndc_label_name": "ValGANciclovir HCl TABLET 450 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268078711",
      "ndc_label_name": "ValGANciclovir HCl TABLET 450 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69097027703",
      "ndc_label_name": "valGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739007633",
      "ndc_label_name": "valGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084096525",
      "ndc_label_name": "ValGANciclovir HCl TABLET 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "55111076260",
      "ndc_label_name": "ValGANciclovir HCl TABLET 450 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904679610",
      "ndc_label_name": "ValGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380016101",
      "ndc_label_name": "valGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084096595",
      "ndc_label_name": "ValGANciclovir HCl TABLET 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63739035733",
      "ndc_label_name": "valGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241015860",
      "ndc_label_name": "ValGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "64380015301",
      "ndc_label_name": "valGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603075001",
      "ndc_label_name": "valGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68084096518",
      "ndc_label_name": "valGANciclovir HCl Tablet 450 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722083260",
      "ndc_label_name": "ValGANciclovir HCl TABLET 450 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50268078712",
      "ndc_label_name": "ValGANciclovir HCl TABLET 450 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43353008553",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "17856015201",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008590",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291084401",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591401201",
      "ndc_label_name": "Valproic Acid CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010770",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00832031011",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008570",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027953",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010790",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010760",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008580",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008560",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959067160",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027994",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010753",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027970",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008594",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027960",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010794",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353010780",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71930005712",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189026730",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739008610",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027990",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739025340",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353027980",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452015020",
      "ndc_label_name": "Valproic Acid CAPSULE 250 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629245401",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090670",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090690",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090680",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518007901",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162191701",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544047994",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189001030",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518007900",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090630",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090653",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090660",
      "ndc_label_name": "Valproic Acid Capsule 250 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121135000",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121067585",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383079205",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383079216",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383079212",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121467500",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121067516",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00527525070",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121467540",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121135010",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383079210",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687026256",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "81033026650",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135019624",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00121467505",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335225001",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60432062116",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50383079207",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687026242",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999019645",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135019645",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62559026616",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135019647",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70752020212",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68999019624",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72603025301",
      "ndc_label_name": "Valproic Acid Solution 250 MG/5ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722074790",
      "ndc_label_name": "Valsartan TABLET 160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135077090",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300023419",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781561892",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255000",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005930",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378581477",
      "ndc_label_name": "Valsartan TABLET 160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342006410",
      "ndc_label_name": "Valsartan TABLET 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005917",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015390",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090634800",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090255001",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090519100",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090519101",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023130",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036909",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090243500",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291085890",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090634801",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090310800",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074815",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074811",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023183",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268078515",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180027809",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090243501",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009705",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51660014290",
      "ndc_label_name": "Valsartan TABLET 160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063401",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268078511",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090310801",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578013316",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009703",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004690",
      "ndc_label_name": "Valsartan TABLET 160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004671",
      "ndc_label_name": "Valsartan TABLET 160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746036290",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180027803",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111073390",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009701",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789028160",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804015430",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877041790",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009702",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162083909",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804015490",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687063411",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335009704",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862057290",
      "ndc_label_name": "Valsartan TABLET 160 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189005030",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72819018309",
      "ndc_label_name": "Valsartan Tablet 160 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300023519",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135077190",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268078611",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353020379",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722074890",
      "ndc_label_name": "Valsartan TABLET 320 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378581577",
      "ndc_label_name": "Valsartan TABLET 320 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090731200",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781561992",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023283",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342006510",
      "ndc_label_name": "Valsartan TABLET 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180027902",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023279",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006783",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015490",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074913",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268078613",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047502",
      "ndc_label_name": "Valsartan TABLET 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090634600",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205030190",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090634601",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090287701",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291085990",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877041890",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746036390",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004771",
      "ndc_label_name": "Valsartan TABLET 320 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862057390",
      "ndc_label_name": "Valsartan TABLET 320 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578013416",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090731201",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004790",
      "ndc_label_name": "Valsartan TABLET 320 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547037009",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162084009",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047503",
      "ndc_label_name": "Valsartan TABLET 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180027909",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51660014390",
      "ndc_label_name": "Valsartan TABLET 320 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090287700",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335047501",
      "ndc_label_name": "Valsartan TABLET 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074911",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72819018409",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111073490",
      "ndc_label_name": "Valsartan Tablet 320 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300023213",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061221",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015130",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268078315",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51660014030",
      "ndc_label_name": "Valsartan TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378580793",
      "ndc_label_name": "Valsartan TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781560731",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135076830",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342006207",
      "ndc_label_name": "Valsartan TABLET 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162083703",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268078311",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004430",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687061211",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036709",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291085630",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722074530",
      "ndc_label_name": "Valsartan TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111073190",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578013106",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746036030",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180027606",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004490",
      "ndc_label_name": "Valsartan TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72819018103",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036703",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074615",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877041530",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111073130",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180027601",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862057030",
      "ndc_label_name": "Valsartan TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074611",
      "ndc_label_name": "Valsartan Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342006310",
      "ndc_label_name": "Valsartan TABLET 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687062301",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300023319",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547036809",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722074690",
      "ndc_label_name": "Valsartan TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781560892",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378581377",
      "ndc_label_name": "Valsartan TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722015290",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090634701",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687062311",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242401",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090243300",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022517",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353006617",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135076990",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59746036190",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074711",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004571",
      "ndc_label_name": "Valsartan TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268074715",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353022530",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090243301",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180027703",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291085790",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090242400",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862057190",
      "ndc_label_name": "Valsartan TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004930",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268078411",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268078415",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251800",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004960",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251801",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189004990",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162083809",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72819018209",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111073290",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180027709",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090519001",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877041690",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090634700",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51660014190",
      "ndc_label_name": "Valsartan TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332004590",
      "ndc_label_name": "Valsartan TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189055030",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578013216",
      "ndc_label_name": "Valsartan Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862054899",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007510",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378632277",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007515",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090141201",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332008071",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291096690",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781594992",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090623200",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547031209",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090141200",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919079030",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788709",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846309",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846306",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090623201",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788846303",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180010409",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332008090",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335022701",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205025890",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788703",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862054890",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335022702",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180010402",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788788706",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205025830",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335261702",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291096790",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378632377",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007610",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180010509",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 160-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781595092",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919097230",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781595064",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862054999",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332008190",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007615",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090176300",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 160-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180010502",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 160-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090621000",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332008171",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547031309",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090598500",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090744400",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862054990",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 160-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335263302",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 160-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547031409",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 320-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007715",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 320-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291096890",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 320-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378632477",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 320-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090557000",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 320-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007710",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 320-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862055090",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 320-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781595192",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 320-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180010102",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 320-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332008271",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 320-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090348500",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 320-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090142200",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 320-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090744200",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 320-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205004290",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 320-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862055005",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 320-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332008290",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 320-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180010109",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 320-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205000490",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 320-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291096990",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 320-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781595210",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 320-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378632577",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 320-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007815",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 320-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264000",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 320-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090534500",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 320-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862055105",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 320-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007810",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 320-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610032760",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 320-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781595292",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 320-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335085301",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 320-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547031509",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 320-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180010202",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 320-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332008371",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 320-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180010209",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 320-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090744300",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 320-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332008390",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 320-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862055190",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 320-25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205001590",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 320-25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090329200",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 80-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862054790",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 80-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378632177",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 80-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43547031109",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 80-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291096590",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 80-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090142000",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 80-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007444",
      "ndc_label_name": "Valsartan-hydroCHLOROthiazide Tablet 80-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342007410",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 80-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090357600",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 80-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862054799",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 80-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063430",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 80-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332007990",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 80-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919063490",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 80-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205032790",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 80-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180010302",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 80-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332007971",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 80-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919076030",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 80-12.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180010309",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 80-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205032730",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide Tablet 80-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187094330",
      "ndc_label_name": "Valsartan-Hydrochlorothiazide TABLET 80-12.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72252051002",
      "ndc_label_name": "Valtoco 10 MG Dose Liquid 10 MG/0.1ML Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72252051005",
      "ndc_label_name": "Valtoco 10 MG Dose Liquid 10 MG/0.1ML Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72252051504",
      "ndc_label_name": "Valtoco 15 MG Dose Liquid Therapy Pack 2 x 7.5 MG/0.1ML Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72252051510",
      "ndc_label_name": "Valtoco 15 MG Dose Liquid Therapy Pack 2 x 7.5 MG/0.1ML Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72252051504",
      "ndc_label_name": "Valtoco 15 MG Dose Liquid Therapy Pack 7.5 MG/0.1ML Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72252052004",
      "ndc_label_name": "Valtoco 20 MG Dose Liquid Therapy Pack 10 MG/0.1ML Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72252052004",
      "ndc_label_name": "Valtoco 20 MG Dose Liquid Therapy Pack 2 x 10 MG/0.1ML Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72252052010",
      "ndc_label_name": "Valtoco 20 MG Dose Liquid Therapy Pack 2 x 10 MG/0.1ML Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72252050502",
      "ndc_label_name": "Valtoco 5 MG Dose Liquid 5 MG/0.1ML Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72252050505",
      "ndc_label_name": "Valtoco 5 MG Dose Liquid 5 MG/0.1ML Nasal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877075081",
      "ndc_label_name": "Vancomycin HCl Solution Reconstituted 25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536010710",
      "ndc_label_name": "Vancomycin HCl Solution Reconstituted 25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536010405",
      "ndc_label_name": "Vancomycin HCl Solution Reconstituted 25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877075058",
      "ndc_label_name": "Vancomycin HCl Solution Reconstituted 25 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536010810",
      "ndc_label_name": "Vancomycin HCl Solution Reconstituted 50 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52536010605",
      "ndc_label_name": "Vancomycin HCl Solution Reconstituted 50 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877075158",
      "ndc_label_name": "Vancomycin HCl Solution Reconstituted 50 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67877075181",
      "ndc_label_name": "Vancomycin HCl Solution Reconstituted 50 MG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006409501",
      "ndc_label_name": "Vaqta Suspension Prefilled Syringe 25 UNIT/0.5ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884094499",
      "ndc_label_name": "Varenicline Tartrate 0.5 MG X 11 & 1 MG X 42 Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090644700",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722067856",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291092756",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342048919",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135080856",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378508973",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598090756",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904741335",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407075556",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505361305",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710161306",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315040256",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921030856",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241017356",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603047601",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462089356",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884015576",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748012749",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090713500",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877074395",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162221802",
      "ndc_label_name": "Varenicline Tartrate Tablet 0.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60505361405",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00378509073",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "69315040356",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00904741435",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "31722067956",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090718200",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687089321",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "33342049019",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "49884015676",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "10135080956",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "67877074495",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "27241017456",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50090644600",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462089456",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "68462089404",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "51407075656",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "71921030956",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687064821",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291092856",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70710161406",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "43598090856",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687089311",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "60687064811",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "70748012849",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162221902",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72162221903",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "72603047701",
      "ndc_label_name": "Varenicline Tartrate Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00006432902",
      "ndc_label_name": "Vaxneuvance Suspension Prefilled Syringe 0.5 ML Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52925011201",
      "ndc_label_name": "VCF Vaginal Contraceptive FILM 28 % VAGINAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "52925031214",
      "ndc_label_name": "VCF Vaginal Contraceptive Foam 12.5 % Vaginal",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "61958290102",
      "ndc_label_name": "Veklury Solution Reconstituted 100 MG Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00555905179",
      "ndc_label_name": "Velivet Tablet 0.1/0.125/0.15 -0.025 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00555905167",
      "ndc_label_name": "Velivet Tablet 0.1/0.125/0.15 -0.025 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53436016801",
      "ndc_label_name": "Veltassa PACKET 16.8 GM ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53436016830",
      "ndc_label_name": "Veltassa PACKET 16.8 GM ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53436025201",
      "ndc_label_name": "Veltassa PACKET 25.2 GM ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53436025230",
      "ndc_label_name": "Veltassa PACKET 25.2 GM ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53436008430",
      "ndc_label_name": "Veltassa PACKET 8.4 GM ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53436008401",
      "ndc_label_name": "Veltassa PACKET 8.4 GM ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53436008492",
      "ndc_label_name": "Veltassa Packet 8.4 GM Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53436008404",
      "ndc_label_name": "Veltassa PACKET 8.4 GM ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958230101",
      "ndc_label_name": "Vemlidy TABLET 25 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00074057928",
      "ndc_label_name": "Venclexta Starting Pack Tablet Therapy Pack 10 & 50 & 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074056111",
      "ndc_label_name": "Venclexta TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074056114",
      "ndc_label_name": "Venclexta TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074057611",
      "ndc_label_name": "Venclexta TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074057630",
      "ndc_label_name": "Venclexta Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074057622",
      "ndc_label_name": "Venclexta TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074057634",
      "ndc_label_name": "Venclexta Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074056607",
      "ndc_label_name": "Venclexta TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00074056611",
      "ndc_label_name": "Venclexta TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093738656",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668002030",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722000430",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082790",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093738698",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082730",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093738605",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082710",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904748961",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089990",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722000490",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019607",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904707661",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019610",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023479",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806060305",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668002090",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598000230",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090121600",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089950",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714004501",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089930",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589000",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023453",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806060309",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081915",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090121601",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806060330",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598000205",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086953",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862069790",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090732400",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598000290",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788680601",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090572501",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251900",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090251901",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353086979",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084071311",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343013330",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090572500",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788680606",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090689600",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090732301",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090732300",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589001",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010018609",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343013390",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268087515",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875206",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081911",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862069701",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700088790",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700091430",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063290",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919084830",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382003610",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877403",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268087511",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788680609",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700091490",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187042030",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187042090",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332079490",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788680603",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877406",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382003616",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788807203",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332079430",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862069705",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788680602",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382003606",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921017409",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877408",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877401",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788807206",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862069730",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001379",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877402",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875209",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888018190",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710170009",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010018605",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788875203",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084071301",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189006630",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710170000",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788877409",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063201",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888018130",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335164202",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010018603",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788680608",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335164201",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335164203",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063215",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063260",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335249503",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029701",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029703",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788807209",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001353",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425019402",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921017433",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008802",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063230",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804003830",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029702",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009005805",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093738405",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093738456",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904707561",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093738498",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001890",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714004301",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904646861",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019407",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806060110",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904748761",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082590",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082510",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714004302",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089790",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082530",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089750",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353089679",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598099910",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001830",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722000230",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356079160",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090330100",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019410",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090308400",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090228100",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090297300",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090630100",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722000290",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353026879",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343013130",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806060130",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090594200",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090592900",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081715",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760083630",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356079130",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090288600",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919042730",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353026830",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268087315",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090592901",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268087311",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084069801",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089730",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090593000",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084069811",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598099930",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919042760",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081711",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332079290",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010018410",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806060109",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090594201",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868206",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598099990",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332079230",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343013190",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052701",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090228101",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090288601",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382003406",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868209",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090574800",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052730",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187048130",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052790",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700097530",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090574801",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710169809",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036360",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187048160",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791903",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189036330",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382003416",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788683406",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090683400",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029001",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888017930",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789103",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868203",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868201",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789106",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010018403",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090683401",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205081230",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063001",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888017990",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788868208",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063030",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791906",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029003",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052799",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047602",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010018405",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010018409",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205040860",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382003410",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029002",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710169800",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788789108",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205040830",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788791909",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921017233",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335970501",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063090",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921017209",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063015",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063060",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047601",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047603",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009005610",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722000330",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082690",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093738556",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904707761",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019507",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093738505",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714004402",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001930",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722000390",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090289400",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082610",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904748861",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806060210",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093738598",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598000190",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806060209",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089830",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589100",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668001990",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090218000",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806060230",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "10135082630",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343013290",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573200",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089850",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090589101",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342019510",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573101",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598000130",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714004401",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332079390",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090731701",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023379",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090651700",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598000110",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268087411",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090121401",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089890",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187017760",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090731900",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629332501",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081811",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081815",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332079330",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090573100",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353088279",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629332502",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919092030",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052830",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343013230",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081330",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788642406",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090621401",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090218001",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869406",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187017730",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084070911",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118018109",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081360",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788806809",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090731700",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090621400",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869409",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382003506",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788642401",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629332503",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118018103",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869403",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052890",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090621500",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883709",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788814006",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788806803",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052801",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022260",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010018505",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862052899",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090659900",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934049430",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883703",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788806806",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084070901",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187017790",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010018509",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788642403",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268087415",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610001879",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934034930",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710169900",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382003510",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788642409",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934034990",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010018503",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919022230",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189041490",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921017309",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335242101",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788642408",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205036930",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063115",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71921017333",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382003516",
      "ndc_label_name": "Venlafaxine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063101",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039601",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888018090",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788814003",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189041430",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047101",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189041460",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788642402",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063130",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047202",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063190",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70010018510",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047003",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788814009",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420063160",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70710169909",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039602",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788883706",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047001",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934073590",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008005130",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335186801",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029601",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72888018030",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047002",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029603",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425029602",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047201",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047102",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039603",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047103",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425047203",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82009005710",
      "ndc_label_name": "Venlafaxine HCl ER Capsule Extended Release 24 Hour 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237017690",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714065901",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089690",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407045790",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187075230",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155025001",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093916301",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089650",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040801",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040820",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332001231",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959060630",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001015600",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335018502",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959060660",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237017601",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335018504",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335018503",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335018501",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664039688",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382010101",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111054990",
      "ndc_label_name": "Venlafaxine HCl Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093914701",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155024601",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268079815",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268079811",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040401",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407045390",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382001801",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111054590",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714065501",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237017201",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002158500",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664039288",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089290",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237017290",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084089695",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001015700",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332000831",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084089625",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040460",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "82804012430",
      "ndc_label_name": "Venlafaxine HCl Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093914801",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111054690",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714065601",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089390",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090486500",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268079911",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155024701",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353037053",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090221000",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237017301",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760018760",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090486501",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760072860",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407045490",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002119700",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353068953",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090485301",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382001901",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064460",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001015800",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919064430",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664039388",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002119703",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090485300",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268079915",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919094030",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332000931",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084084401",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040501",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040590",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237017390",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919061730",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111054605",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084084411",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919094060",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335121302",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040560",
      "ndc_label_name": "Venlafaxine HCl Tablet 37.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407045590",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268080015",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237017401",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111054790",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089490",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714065701",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093914901",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268080011",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919065730",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332001031",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664039488",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040690",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237017490",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382002001",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155024801",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040601",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001015900",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040630",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919093830",
      "ndc_label_name": "Venlafaxine HCl Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155024901",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714065801",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353042116",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089550",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353042153",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093915701",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291089590",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353042130",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079817",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353042170",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353042180",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111054805",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353042160",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063390",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079884",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079870",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079860",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069060",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069053",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237017501",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069080",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353042184",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220901",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079888",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268080113",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069070",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069084",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629332402",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090220900",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353069030",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090240800",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090240801",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57664039588",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079880",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090471501",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040730",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090471500",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353079853",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407045690",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959089030",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049590",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053530",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111054890",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049530",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959089060",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053590",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959089090",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071069430",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919080430",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092930",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700081690",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335110404",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002135800",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862040701",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760030430",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335010602",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071069428",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760071330",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002135803",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335110402",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382002101",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919049560",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237017590",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001016000",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919053560",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071069460",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62332001131",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085601",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187092960",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610060617",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084085611",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335110401",
      "ndc_label_name": "Venlafaxine HCl Tablet 75 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090731101",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440860860",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440860890",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834032001",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002146703",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049311",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090140001",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440860830",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002146700",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071001130",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187084930",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090140000",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869601",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029201",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788632803",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687049301",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869603",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788869609",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099280",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002120500",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090058404",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440860960",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999028400",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834015805",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440860930",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440860994",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090525304",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353099260",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050411",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025860",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040560",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610025880",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440860990",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002120503",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029301",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789041690",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687050401",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834015801",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462029305",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610040580",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 180 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094060",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090156604",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440861090",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440861010",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002112900",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440861060",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440861030",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999007500",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090458200",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002112903",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687051501",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353094030",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289072390",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440861094",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090156600",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090458204",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205001790",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205001730",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026001",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289072330",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289072393",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687051511",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959005030",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462026005",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834015901",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610037760",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267021230",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "75834015905",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610026860",
      "ndc_label_name": "Verapamil HCl ER Tablet Extended Release 240 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591034501",
      "ndc_label_name": "Verapamil HCl TABLET 120 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090015602",
      "ndc_label_name": "Verapamil HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155048601",
      "ndc_label_name": "Verapamil HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090259502",
      "ndc_label_name": "Verapamil HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591034510",
      "ndc_label_name": "Verapamil HCl TABLET 120 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090401302",
      "ndc_label_name": "Verapamil HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591034505",
      "ndc_label_name": "Verapamil HCl TABLET 120 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135074590",
      "ndc_label_name": "Verapamil HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934037130",
      "ndc_label_name": "Verapamil HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919088130",
      "ndc_label_name": "Verapamil HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291085501",
      "ndc_label_name": "Verapamil HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788833803",
      "ndc_label_name": "Verapamil HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999028300",
      "ndc_label_name": "Verapamil HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090401300",
      "ndc_label_name": "Verapamil HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090259500",
      "ndc_label_name": "Verapamil HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090015600",
      "ndc_label_name": "Verapamil HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407096401",
      "ndc_label_name": "Verapamil HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205012930",
      "ndc_label_name": "Verapamil HCl Tablet 120 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591040401",
      "ndc_label_name": "Verapamil HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407096201",
      "ndc_label_name": "Verapamil HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155005901",
      "ndc_label_name": "Verapamil HCl TABLET 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291085301",
      "ndc_label_name": "Verapamil HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135074390",
      "ndc_label_name": "Verapamil HCl Tablet 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591034305",
      "ndc_label_name": "Verapamil HCl TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591034310",
      "ndc_label_name": "Verapamil HCl TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289089608",
      "ndc_label_name": "Verapamil HCl TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55289089630",
      "ndc_label_name": "Verapamil HCl TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999031000",
      "ndc_label_name": "Verapamil HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135074490",
      "ndc_label_name": "Verapamil HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591034301",
      "ndc_label_name": "Verapamil HCl TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291085401",
      "ndc_label_name": "Verapamil HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23155002601",
      "ndc_label_name": "Verapamil HCl TABLET 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999031060",
      "ndc_label_name": "Verapamil HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407096301",
      "ndc_label_name": "Verapamil HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162223201",
      "ndc_label_name": "Verapamil HCl Tablet 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002481554",
      "ndc_label_name": "Verzenio TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002533754",
      "ndc_label_name": "Verzenio TABLET 150 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002621654",
      "ndc_label_name": "Verzenio TABLET 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002448354",
      "ndc_label_name": "Verzenio TABLET 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093400062",
      "ndc_label_name": "Vestura Tablet 3-0.02 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093400028",
      "ndc_label_name": "Vestura Tablet 3-0.02 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480400028",
      "ndc_label_name": "Vestura Tablet 3-0.02 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00480400062",
      "ndc_label_name": "Vestura Tablet 3-0.02 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "23900001438",
      "ndc_label_name": "Vicks DayQuil Mucus Control DM Liquid 10-200 MG/15ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "70710128701",
      "ndc_label_name": "Vigabatrin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69238142401",
      "ndc_label_name": "Vigabatrin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00054065225",
      "ndc_label_name": "Vigabatrin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43598065101",
      "ndc_label_name": "Vigabatrin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651036701",
      "ndc_label_name": "Vigabatrin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00574020101",
      "ndc_label_name": "Vigabatrin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42799095001",
      "ndc_label_name": "Vigabatrin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00591385101",
      "ndc_label_name": "Vigabatrin Tablet 500 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245055689",
      "ndc_label_name": "Vigadrone Packet 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00245055650",
      "ndc_label_name": "Vigadrone Packet 500 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51991017801",
      "ndc_label_name": "Vinate II Tablet 29-1 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73562010410",
      "ndc_label_name": "Viokace Tablet 10440-39150 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73562020810",
      "ndc_label_name": "Viokace Tablet 20880-78300 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "52959028906",
      "ndc_label_name": "Viracept Tablet 250 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999043103",
      "ndc_label_name": "Viracept Tablet 250 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63010001030",
      "ndc_label_name": "Viracept TABLET 250 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267051418",
      "ndc_label_name": "Viracept TABLET 250 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "66267051463",
      "ndc_label_name": "Viracept TABLET 250 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959028930",
      "ndc_label_name": "Viracept Tablet 250 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63010002770",
      "ndc_label_name": "Viracept TABLET 625 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958040301",
      "ndc_label_name": "Viread POWDER 40 MG/GM ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958040401",
      "ndc_label_name": "Viread TABLET 150 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958040501",
      "ndc_label_name": "Viread TABLET 200 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61958040601",
      "ndc_label_name": "Viread TABLET 250 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00642007912",
      "ndc_label_name": "Vitafol-OB TABLET ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68094011661",
      "ndc_label_name": "Vitamin B-1 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "48433010801",
      "ndc_label_name": "Vitamin B-1 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80681009700",
      "ndc_label_name": "Vitamin B-1 Tablet 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58487000801",
      "ndc_label_name": "Vitamin B-1 TABLET 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917007931",
      "ndc_label_name": "Vitamin B-12 ER Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768003545",
      "ndc_label_name": "Vitamin B-12 ER Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917006548",
      "ndc_label_name": "Vitamin B-12 ER Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604002929",
      "ndc_label_name": "Vitamin B-12 ER Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49614065572",
      "ndc_label_name": "Vitamin B-12 ER Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845008055",
      "ndc_label_name": "Vitamin B-12 ER Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00761022120",
      "ndc_label_name": "Vitamin B-12 ER Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295012792",
      "ndc_label_name": "Vitamin B-12 ER Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917015293",
      "ndc_label_name": "Vitamin B-12 ER Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055526",
      "ndc_label_name": "Vitamin B-12 ER Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917003941",
      "ndc_label_name": "Vitamin B-12 ER Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295013579",
      "ndc_label_name": "Vitamin B-12 ER Tablet Extended Release 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629005801",
      "ndc_label_name": "Vitamin B-12 TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896085601",
      "ndc_label_name": "Vitamin B-12 TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681007100",
      "ndc_label_name": "Vitamin B-12 Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00761037220",
      "ndc_label_name": "Vitamin B-12 TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007928",
      "ndc_label_name": "Vitamin B-12 TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292056358",
      "ndc_label_name": "Vitamin B-12 TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055566",
      "ndc_label_name": "Vitamin B-12 TABLET 100 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312001170",
      "ndc_label_name": "Vitamin B-12 Tablet 100 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10006070022",
      "ndc_label_name": "Vitamin B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10006073043",
      "ndc_label_name": "Vitamin B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11845006935",
      "ndc_label_name": "Vitamin B-12 TABLET 1000 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00904740361",
      "ndc_label_name": "Vitamin B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292056405",
      "ndc_label_name": "Vitamin B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536136601",
      "ndc_label_name": "Vitamin B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268085511",
      "ndc_label_name": "Vitamin B-12 TABLET 1000 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268085515",
      "ndc_label_name": "Vitamin B-12 TABLET 1000 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768060693",
      "ndc_label_name": "Vitamin B-12 TABLET 1000 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864091401",
      "ndc_label_name": "Vitamin B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "20555001600",
      "ndc_label_name": "Vitamin B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "20555000600",
      "ndc_label_name": "Vitamin B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54738000333",
      "ndc_label_name": "Vitamin B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896089601",
      "ndc_label_name": "Vitamin B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629058605",
      "ndc_label_name": "Vitamin B-12 TABLET 1000 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312001380",
      "ndc_label_name": "Vitamin B-12 TABLET 1000 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54738000350",
      "ndc_label_name": "Vitamin B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69618003701",
      "ndc_label_name": "Vitamin B-12 TABLET 1000 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333093810",
      "ndc_label_name": "Vitamin B-12 TABLET 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "96295013587",
      "ndc_label_name": "Vitamin B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68094011561",
      "ndc_label_name": "Vitamin B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54738000301",
      "ndc_label_name": "Vitamin B-12 Tablet 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333093825",
      "ndc_label_name": "Vitamin B-12 TABLET 1000 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312052805",
      "ndc_label_name": "Vitamin B-12 TABLET 1000 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94604010450",
      "ndc_label_name": "Vitamin B-12 TABLET 1000 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768004067",
      "ndc_label_name": "Vitamin B-12 Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268085315",
      "ndc_label_name": "Vitamin B-12 TABLET 250 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268085311",
      "ndc_label_name": "Vitamin B-12 TABLET 250 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00536141638",
      "ndc_label_name": "Vitamin B-12 Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54738000133",
      "ndc_label_name": "Vitamin B-12 Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768003989",
      "ndc_label_name": "Vitamin B-12 Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292012349",
      "ndc_label_name": "Vitamin B-12 TABLET 250 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94604010430",
      "ndc_label_name": "Vitamin B-12 TABLET 250 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604001289",
      "ndc_label_name": "Vitamin B-12 TABLET 250 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629058001",
      "ndc_label_name": "Vitamin B-12 TABLET 250 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312000660",
      "ndc_label_name": "Vitamin B-12 Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681016500",
      "ndc_label_name": "Vitamin B-12 Tablet 250 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "20555003200",
      "ndc_label_name": "Vitamin B-12 Tablet 500 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00761044020",
      "ndc_label_name": "Vitamin B-12 TABLET 500 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864091301",
      "ndc_label_name": "Vitamin B-12 Tablet 500 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917007929",
      "ndc_label_name": "Vitamin B-12 TABLET 500 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917003940",
      "ndc_label_name": "Vitamin B-12 TABLET 500 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604001290",
      "ndc_label_name": "Vitamin B-12 TABLET 500 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "11917006545",
      "ndc_label_name": "Vitamin B-12 TABLET 500 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268085411",
      "ndc_label_name": "Vitamin B-12 TABLET 500 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353063180",
      "ndc_label_name": "Vitamin B-12 Tablet 500 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "57896088601",
      "ndc_label_name": "Vitamin B-12 Tablet 500 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "94604010440",
      "ndc_label_name": "Vitamin B-12 TABLET 500 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629058501",
      "ndc_label_name": "Vitamin B-12 TABLET 500 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768000576",
      "ndc_label_name": "Vitamin B-12 Tablet 500 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681007200",
      "ndc_label_name": "Vitamin B-12 Tablet 500 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43353063160",
      "ndc_label_name": "Vitamin B-12 Tablet 500 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333093710",
      "ndc_label_name": "Vitamin B-12 TABLET 500 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "50268085415",
      "ndc_label_name": "Vitamin B-12 TABLET 500 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768012608",
      "ndc_label_name": "Vitamin B-12 TABLET 500 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333093725",
      "ndc_label_name": "Vitamin B-12 TABLET 500 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "31604001079",
      "ndc_label_name": "Vitamin B-12 TABLET 500 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "80681012800",
      "ndc_label_name": "Vitamin B-12 Tablet 500 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "49614065478",
      "ndc_label_name": "Vitamin B-12 Tablet 500 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312001370",
      "ndc_label_name": "Vitamin B-12 Tablet 500 MCG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "78742000986",
      "ndc_label_name": "Vitamin B-12 TABLET 500 MCG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629438002",
      "ndc_label_name": "Vitamin B-12 Tablet Sublingual 1000 MCG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055992",
      "ndc_label_name": "Vitamin B-12 Tablet Sublingual 1000 MCG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629438001",
      "ndc_label_name": "Vitamin B-12 Tablet Sublingual 1000 MCG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58765000054",
      "ndc_label_name": "Vitamin B-12 Tablet Sublingual 1000 MCG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629438005",
      "ndc_label_name": "Vitamin B-12 Tablet Sublingual 1000 MCG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629438003",
      "ndc_label_name": "Vitamin B-12 Tablet Sublingual 1000 MCG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "63629438004",
      "ndc_label_name": "Vitamin B-12 Tablet Sublingual 1000 MCG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00761051612",
      "ndc_label_name": "Vitamin B-12 Tablet Sublingual 2500 MCG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "30768003988",
      "ndc_label_name": "Vitamin B-12 Tablet Sublingual 2500 MCG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629055100",
      "ndc_label_name": "Vitamin B-12 Tablet Sublingual 2500 MCG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292055993",
      "ndc_label_name": "Vitamin B-12 Tablet Sublingual 500 MCG Sublingual",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "48107012169",
      "ndc_label_name": "Vitamin B-2 TABLET 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "74312000640",
      "ndc_label_name": "Vitamin B-2 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "58487000601",
      "ndc_label_name": "Vitamin B-2 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "10135078801",
      "ndc_label_name": "Vitamin B-2 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "54629009501",
      "ndc_label_name": "Vitamin B-2 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "43292056000",
      "ndc_label_name": "Vitamin B-2 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "07610003220",
      "ndc_label_name": "Vitamin B-2 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864094101",
      "ndc_label_name": "Vitamin B-2 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "69375001210",
      "ndc_label_name": "Vitamin B-2 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "00761022312",
      "ndc_label_name": "Vitamin B-6 ER Tablet Extended Release 200 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "74312000650",
      "ndc_label_name": "Vitamin B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917003939",
      "ndc_label_name": "Vitamin B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "35046000123",
      "ndc_label_name": "Vitamin B-6 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "31604001285",
      "ndc_label_name": "Vitamin B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917013989",
      "ndc_label_name": "Vitamin B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917006544",
      "ndc_label_name": "Vitamin B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917003926",
      "ndc_label_name": "Vitamin B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917013973",
      "ndc_label_name": "Vitamin B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268085915",
      "ndc_label_name": "Vitamin B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49999080330",
      "ndc_label_name": "Vitamin B-6 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268085911",
      "ndc_label_name": "Vitamin B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30768000571",
      "ndc_label_name": "Vitamin B-6 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54629063001",
      "ndc_label_name": "Vitamin B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30768012590",
      "ndc_label_name": "Vitamin B-6 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917007957",
      "ndc_label_name": "Vitamin B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "49614059378",
      "ndc_label_name": "Vitamin B-6 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58487000882",
      "ndc_label_name": "Vitamin B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959021500",
      "ndc_label_name": "Vitamin B-6 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864091001",
      "ndc_label_name": "Vitamin B-6 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "57896085401",
      "ndc_label_name": "Vitamin B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "77333094510",
      "ndc_label_name": "Vitamin B-6 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959021520",
      "ndc_label_name": "Vitamin B-6 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "58487000881",
      "ndc_label_name": "Vitamin B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "52959021530",
      "ndc_label_name": "Vitamin B-6 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "77333094525",
      "ndc_label_name": "Vitamin B-6 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80681002500",
      "ndc_label_name": "Vitamin B-6 Tablet 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "94604010410",
      "ndc_label_name": "Vitamin B-6 TABLET 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536440601",
      "ndc_label_name": "Vitamin B-6 TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "66267021330",
      "ndc_label_name": "Vitamin B-6 TABLET 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090046401",
      "ndc_label_name": "Vitamin B-6 Tablet 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "42806054701",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208302",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320101",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42806054705",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291026601",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353021903",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208303",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023808",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353021904",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090438201",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760015212",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063071112",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353021912",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353021908",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584401",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081604",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320103",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070208",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187051912",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023803",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023804",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353081603",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919070204",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090208301",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584402",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135043990",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335006201",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023813",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353023812",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090320102",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629244701",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268029711",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64980015701",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404202",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055203",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090438203",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090438202",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335027806",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69452015120",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "64380073706",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404208",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934025208",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055204",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090584403",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187051906",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024013",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934025212",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934081608",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934081612",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70934025230",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055213",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268029715",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404203",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055208",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335006207",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067630",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024004",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067608",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071212",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407070001",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024008",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205067612",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335006208",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335006206",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055268",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055247",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024912",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760027512",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024913",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071203",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610055212",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335027801",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789024901",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162191801",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071204",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788404201",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610071213",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425013003",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788640901",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788640902",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335169106",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024003",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610024012",
      "ndc_label_name": "Vitamin D (Ergocalciferol) Capsule 1.25 MG (50000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43292056299",
      "ndc_label_name": "Vitamin D Tablet 25 MCG (1000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864091901",
      "ndc_label_name": "Vitamin D Tablet 25 MCG (1000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96121000261",
      "ndc_label_name": "Vitamin D Tablet 25 MCG (1000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "31604001870",
      "ndc_label_name": "Vitamin D Tablet 25 MCG (1000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43292056286",
      "ndc_label_name": "Vitamin D Tablet 25 MCG (1000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "43353062460",
      "ndc_label_name": "Vitamin D Tablet 25 MCG (1000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80681013200",
      "ndc_label_name": "Vitamin D Tablet 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "37864092001",
      "ndc_label_name": "Vitamin D Tablet 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80681013100",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "03573015334",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917014360",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "03573015331",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "03573015337",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33739000373",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917014767",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69618004201",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917002191",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917011540",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090509700",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "31604002621",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917013981",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51663000503",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30768029173",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "85633002000",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54629090980",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917017183",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "74312019377",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "71800001901",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "88395014110",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "85633002001",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "90011030005",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "85633002030",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "85633002036",
      "ndc_label_name": "Vitamin D3 Capsule 125 MCG (5000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917011818",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917010706",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00536135301",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917011819",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917013694",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917017096",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917008608",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917016632",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917012703",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917019833",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917012698",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917012697",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "31604002678",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917022013",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917013943",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "85633002100",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917013941",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30768017621",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917013942",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917014678",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917017094",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "69618000901",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "30768019941",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "11917014679",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "45861006701",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090163700",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33674015590",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "33739000377",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54629090970",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "74312019939",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "85633002105",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50090163701",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "51663000520",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295014177",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "85633002130",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "74312052807",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "74312017621",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "80681000900",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "85633002136",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131031282",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295013869",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "81131000720",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295014175",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295013967",
      "ndc_label_name": "Vitamin D3 Capsule 50 MCG (2000 UT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40093011526",
      "ndc_label_name": "Vitamin D3 Extra Strength Tablet Chewable 25 MCG (1000 UT) Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54629077241",
      "ndc_label_name": "Vitamin D3 Liquid 125 MCG/ML Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "31604002671",
      "ndc_label_name": "Vitamin D3 Tablet 10 MCG (400 UNIT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00761005820",
      "ndc_label_name": "Vitamin D3 Tablet 10 MCG (400 UNIT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00904582360",
      "ndc_label_name": "Vitamin D3 Tablet 10 MCG (400 UNIT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094011459",
      "ndc_label_name": "Vitamin D3 Tablet 10 MCG (400 UNIT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "79854001162",
      "ndc_label_name": "Vitamin D3 Tablet 10 MCG (400 UNIT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "77333094825",
      "ndc_label_name": "Vitamin D3 Tablet 10 MCG (400 UNIT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "48433010901",
      "ndc_label_name": "Vitamin D3 Tablet 10 MCG (400 UNIT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268086311",
      "ndc_label_name": "Vitamin D3 Tablet 10 MCG (400 UNIT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "68094011461",
      "ndc_label_name": "Vitamin D3 Tablet 10 MCG (400 UNIT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "50268086315",
      "ndc_label_name": "Vitamin D3 Tablet 10 MCG (400 UNIT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "77333094810",
      "ndc_label_name": "Vitamin D3 Tablet 10 MCG (400 UNIT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "96295012845",
      "ndc_label_name": "Vitamin D3 Tablet 10 MCG (400 UNIT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "31604002604",
      "ndc_label_name": "Vitamin D3 Tablet Chewable 10 MCG (400 UNIT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "40985027380",
      "ndc_label_name": "Vitamin D3 Tablet Chewable 10 MCG (400 UNIT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "54629089821",
      "ndc_label_name": "Vitamin D3 Tablet Chewable 10 MCG (400 UNIT) Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "61958240101",
      "ndc_label_name": "Vosevi TABLET 400-100-100 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69543035610",
      "ndc_label_name": "VP-Vite Rx Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61874011511",
      "ndc_label_name": "Vraylar CAPSULE 1.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61874011520",
      "ndc_label_name": "Vraylar CAPSULE 1.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61874011530",
      "ndc_label_name": "Vraylar CAPSULE 1.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61874013020",
      "ndc_label_name": "Vraylar CAPSULE 3 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61874013011",
      "ndc_label_name": "Vraylar CAPSULE 3 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61874013030",
      "ndc_label_name": "Vraylar CAPSULE 3 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61874014530",
      "ndc_label_name": "Vraylar CAPSULE 4.5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61874016030",
      "ndc_label_name": "Vraylar CAPSULE 6 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61874017008",
      "ndc_label_name": "Vraylar Capsule Therapy Pack 1.5 & 3 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093171201",
      "ndc_label_name": "Warfarin Sodium TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002860",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959092430",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002830",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264601",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722032701",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095000",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282032710",
      "ndc_label_name": "Warfarin Sodium TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093171210",
      "ndc_label_name": "Warfarin Sodium TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058430",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282032701",
      "ndc_label_name": "Warfarin Sodium TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090311001",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034110",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722032710",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058460",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407078410",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237011901",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264600",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090311000",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076111",
      "ndc_label_name": "Warfarin Sodium TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076110",
      "ndc_label_name": "Warfarin Sodium TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407078401",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672402701",
      "ndc_label_name": "Warfarin Sodium TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034101",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095030",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005201",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672402703",
      "ndc_label_name": "Warfarin Sodium TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237011999",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672402707",
      "ndc_label_name": "Warfarin Sodium TABLET 1 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095055",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095064",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005210",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095060",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095011",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095072",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095090",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162222900",
      "ndc_label_name": "Warfarin Sodium Tablet 1 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057830",
      "ndc_label_name": "Warfarin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005430",
      "ndc_label_name": "Warfarin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722033501",
      "ndc_label_name": "Warfarin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403501",
      "ndc_label_name": "Warfarin Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057809",
      "ndc_label_name": "Warfarin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407079201",
      "ndc_label_name": "Warfarin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090203300",
      "ndc_label_name": "Warfarin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093172001",
      "ndc_label_name": "Warfarin Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034901",
      "ndc_label_name": "Warfarin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090722900",
      "ndc_label_name": "Warfarin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403503",
      "ndc_label_name": "Warfarin Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187075030",
      "ndc_label_name": "Warfarin Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237012701",
      "ndc_label_name": "Warfarin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076910",
      "ndc_label_name": "Warfarin Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090326300",
      "ndc_label_name": "Warfarin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189021071",
      "ndc_label_name": "Warfarin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005901",
      "ndc_label_name": "Warfarin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610045830",
      "ndc_label_name": "Warfarin Sodium Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282033501",
      "ndc_label_name": "Warfarin Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187075010",
      "ndc_label_name": "Warfarin Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076911",
      "ndc_label_name": "Warfarin Sodium TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722032810",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406205310",
      "ndc_label_name": "Warfarin Sodium TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002153",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002155",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002130",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005310",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002161",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093171301",
      "ndc_label_name": "Warfarin Sodium TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095164",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002135",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407078501",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002160",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002140",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046235",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034210",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093171310",
      "ndc_label_name": "Warfarin Sodium TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002145",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407078510",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672402803",
      "ndc_label_name": "Warfarin Sodium TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090312000",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002170",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282032810",
      "ndc_label_name": "Warfarin Sodium TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584098401",
      "ndc_label_name": "Warfarin Sodium TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722032801",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090265400",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672402801",
      "ndc_label_name": "Warfarin Sodium TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005301",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076210",
      "ndc_label_name": "Warfarin Sodium TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046230",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672402807",
      "ndc_label_name": "Warfarin Sodium TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076211",
      "ndc_label_name": "Warfarin Sodium TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002150",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046240",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237012001",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095100",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057445",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282032801",
      "ndc_label_name": "Warfarin Sodium TABLET 2 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237012099",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095111",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090746400",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095160",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095155",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095130",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057460",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046260",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048035",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095190",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034201",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048040",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959092530",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046253",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584098411",
      "ndc_label_name": "Warfarin Sodium TABLET 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048045",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095172",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048053",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610046245",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048060",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610048030",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057430",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057435",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057440",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057453",
      "ndc_label_name": "Warfarin Sodium Tablet 2 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002930",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093171401",
      "ndc_label_name": "Warfarin Sodium TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722032901",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093171410",
      "ndc_label_name": "Warfarin Sodium TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002935",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014235",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090258600",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084002711",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002940",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014230",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002953",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722032910",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014245",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014253",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407078610",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095211",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002960",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014240",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672402903",
      "ndc_label_name": "Warfarin Sodium TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002945",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090214101",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353014260",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237012199",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076311",
      "ndc_label_name": "Warfarin Sodium TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090214100",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034301",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629317701",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084002701",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407078601",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090258601",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187074530",
      "ndc_label_name": "Warfarin Sodium TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095264",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034310",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672402907",
      "ndc_label_name": "Warfarin Sodium TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840201",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672402901",
      "ndc_label_name": "Warfarin Sodium TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237012101",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017930",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382006410",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629317702",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840203",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049130",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095200",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382006401",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076310",
      "ndc_label_name": "Warfarin Sodium TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282032901",
      "ndc_label_name": "Warfarin Sodium TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095255",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282032910",
      "ndc_label_name": "Warfarin Sodium TABLET 2.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840206",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095272",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095260",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610059330",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788840209",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095290",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095230",
      "ndc_label_name": "Warfarin Sodium Tablet 2.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093171501",
      "ndc_label_name": "Warfarin Sodium TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403003",
      "ndc_label_name": "Warfarin Sodium TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406205410",
      "ndc_label_name": "Warfarin Sodium TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407078710",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00406205401",
      "ndc_label_name": "Warfarin Sodium TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353003060",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722033001",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722033010",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403007",
      "ndc_label_name": "Warfarin Sodium TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076411",
      "ndc_label_name": "Warfarin Sodium TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008930",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237012299",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353003030",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353008960",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034401",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261300",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095300",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005410",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034410",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076410",
      "ndc_label_name": "Warfarin Sodium TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407078701",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095360",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237012201",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403001",
      "ndc_label_name": "Warfarin Sodium TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095355",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095390",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095311",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095372",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005401",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162223000",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095330",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282033001",
      "ndc_label_name": "Warfarin Sodium TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095364",
      "ndc_label_name": "Warfarin Sodium Tablet 3 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282033010",
      "ndc_label_name": "Warfarin Sodium TABLET 3 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049030",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093171610",
      "ndc_label_name": "Warfarin Sodium TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353004960",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722033101",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282033101",
      "ndc_label_name": "Warfarin Sodium TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093171601",
      "ndc_label_name": "Warfarin Sodium TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403101",
      "ndc_label_name": "Warfarin Sodium TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034510",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282033110",
      "ndc_label_name": "Warfarin Sodium TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407078801",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005501",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353003330",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095400",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722033110",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095460",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403107",
      "ndc_label_name": "Warfarin Sodium TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610058930",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407078810",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076510",
      "ndc_label_name": "Warfarin Sodium TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353004930",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237012399",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264500",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095430",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034501",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005510",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403103",
      "ndc_label_name": "Warfarin Sodium TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189040571",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237012301",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095455",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076511",
      "ndc_label_name": "Warfarin Sodium TABLET 4 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095464",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095411",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095490",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095472",
      "ndc_label_name": "Warfarin Sodium Tablet 4 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722033201",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063017614",
      "ndc_label_name": "Warfarin Sodium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002365",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093172101",
      "ndc_label_name": "Warfarin Sodium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002320",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002340",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063017630",
      "ndc_label_name": "Warfarin Sodium TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722033210",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002344",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002361",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002368",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093172110",
      "ndc_label_name": "Warfarin Sodium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002330",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002346",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002325",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002315",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005015",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005020",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002378",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002311",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002345",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002347",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002328",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002335",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005025",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005038",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005028",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002321",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002355",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002357",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002338",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005011",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005060",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005059",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005040",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002359",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005050",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005046",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002350",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005021",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005070",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005068",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403201",
      "ndc_label_name": "Warfarin Sodium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002360",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999057600",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005061",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002353",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005030",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034610",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005078",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403207",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353002370",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090505800",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005601",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005035",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005044",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005610",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407078910",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959092630",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005047",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543900",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017345",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005045",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005055",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095511",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403203",
      "ndc_label_name": "Warfarin Sodium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187067410",
      "ndc_label_name": "Warfarin Sodium TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005057",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076610",
      "ndc_label_name": "Warfarin Sodium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044815",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005053",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090544000",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095572",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187067490",
      "ndc_label_name": "Warfarin Sodium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095560",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090293602",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044820",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044838",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005065",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034601",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017340",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095500",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017330",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584099401",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044845",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044860",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999057610",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407078901",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044830",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095555",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044821",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62584099411",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044846",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049855",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999057620",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237012401",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044868",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095564",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044844",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187067460",
      "ndc_label_name": "Warfarin Sodium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049830",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057545",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090293600",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919034130",
      "ndc_label_name": "Warfarin Sodium TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057525",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095590",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057520",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629884301",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049840",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282033201",
      "ndc_label_name": "Warfarin Sodium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090293601",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005616",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057540",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044825",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057538",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076611",
      "ndc_label_name": "Warfarin Sodium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049845",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282033210",
      "ndc_label_name": "Warfarin Sodium TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543901",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044811",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057560",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044828",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090543902",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044847",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237012499",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044840",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205095530",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044861",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610017335",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049815",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044835",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044850",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044859",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044853",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049820",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044855",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049825",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610044878",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049835",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049850",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049853",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057515",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610049860",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057530",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057550",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057535",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057555",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610057553",
      "ndc_label_name": "Warfarin Sodium Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403301",
      "ndc_label_name": "Warfarin Sodium TABLET 6 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353058730",
      "ndc_label_name": "Warfarin Sodium Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090261700",
      "ndc_label_name": "Warfarin Sodium Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076711",
      "ndc_label_name": "Warfarin Sodium TABLET 6 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093171801",
      "ndc_label_name": "Warfarin Sodium TABLET 6 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722033301",
      "ndc_label_name": "Warfarin Sodium Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034701",
      "ndc_label_name": "Warfarin Sodium Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403303",
      "ndc_label_name": "Warfarin Sodium TABLET 6 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005701",
      "ndc_label_name": "Warfarin Sodium Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407079010",
      "ndc_label_name": "Warfarin Sodium Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407079001",
      "ndc_label_name": "Warfarin Sodium Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282033301",
      "ndc_label_name": "Warfarin Sodium TABLET 6 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034710",
      "ndc_label_name": "Warfarin Sodium Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076710",
      "ndc_label_name": "Warfarin Sodium TABLET 6 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237012501",
      "ndc_label_name": "Warfarin Sodium Tablet 6 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282033310",
      "ndc_label_name": "Warfarin Sodium TABLET 6 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407034801",
      "ndc_label_name": "Warfarin Sodium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093172301",
      "ndc_label_name": "Warfarin Sodium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353057930",
      "ndc_label_name": "Warfarin Sodium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722033401",
      "ndc_label_name": "Warfarin Sodium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407079101",
      "ndc_label_name": "Warfarin Sodium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353005330",
      "ndc_label_name": "Warfarin Sodium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282033401",
      "ndc_label_name": "Warfarin Sodium TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610051930",
      "ndc_label_name": "Warfarin Sodium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403403",
      "ndc_label_name": "Warfarin Sodium TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999082900",
      "ndc_label_name": "Warfarin Sodium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076810",
      "ndc_label_name": "Warfarin Sodium TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090258200",
      "ndc_label_name": "Warfarin Sodium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "57237012601",
      "ndc_label_name": "Warfarin Sodium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51672403401",
      "ndc_label_name": "Warfarin Sodium TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65162076811",
      "ndc_label_name": "Warfarin Sodium TABLET 7.5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68382005801",
      "ndc_label_name": "Warfarin Sodium Tablet 7.5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "08462122015",
      "ndc_label_name": "Windmill Trainer",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458058451",
      "ndc_label_name": "Xarelto Starter Pack Tablet Therapy Pack 15 & 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458057501",
      "ndc_label_name": "Xarelto Suspension Reconstituted 1 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458058001",
      "ndc_label_name": "Xarelto Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090446900",
      "ndc_label_name": "Xarelto Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458058090",
      "ndc_label_name": "Xarelto TABLET 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090362500",
      "ndc_label_name": "Xarelto Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458058010",
      "ndc_label_name": "Xarelto TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090362501",
      "ndc_label_name": "Xarelto Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610069042",
      "ndc_label_name": "Xarelto Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458058030",
      "ndc_label_name": "Xarelto TABLET 10 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154142200",
      "ndc_label_name": "Xarelto Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458057801",
      "ndc_label_name": "Xarelto Tablet 15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458057810",
      "ndc_label_name": "Xarelto TABLET 15 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458057890",
      "ndc_label_name": "Xarelto TABLET 15 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458057830",
      "ndc_label_name": "Xarelto TABLET 15 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154142408",
      "ndc_label_name": "Xarelto Tablet 15 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458057701",
      "ndc_label_name": "Xarelto Tablet 2.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458057718",
      "ndc_label_name": "Xarelto Tablet 2.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458057710",
      "ndc_label_name": "Xarelto Tablet 2.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458057714",
      "ndc_label_name": "Xarelto Tablet 2.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458057760",
      "ndc_label_name": "Xarelto Tablet 2.5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458057901",
      "ndc_label_name": "Xarelto Tablet 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090363900",
      "ndc_label_name": "Xarelto Tablet 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458057989",
      "ndc_label_name": "Xarelto Tablet 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458057910",
      "ndc_label_name": "Xarelto TABLET 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458057930",
      "ndc_label_name": "Xarelto TABLET 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50458057990",
      "ndc_label_name": "Xarelto TABLET 20 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090446800",
      "ndc_label_name": "Xarelto Tablet 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55154142308",
      "ndc_label_name": "Xarelto Tablet 20 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00069102901",
      "ndc_label_name": "Xeljanz Solution 1 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069102902",
      "ndc_label_name": "Xeljanz Solution 1 MG/ML Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069100201",
      "ndc_label_name": "Xeljanz Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63539001602",
      "ndc_label_name": "Xeljanz Tablet 10 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069100101",
      "ndc_label_name": "Xeljanz TABLET 5 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63539001202",
      "ndc_label_name": "Xeljanz Tablet 5 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63539050130",
      "ndc_label_name": "Xeljanz XR Tablet Extended Release 24 Hour 11 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069050130",
      "ndc_label_name": "Xeljanz XR Tablet Extended Release 24 Hour 11 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00069050230",
      "ndc_label_name": "Xeljanz XR Tablet Extended Release 24 Hour 22 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "63539050230",
      "ndc_label_name": "Xeljanz XR Tablet Extended Release 24 Hour 22 MG Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "50242021503",
      "ndc_label_name": "Xolair Solution Prefilled Syringe 150 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242021586",
      "ndc_label_name": "Xolair Solution Prefilled Syringe 150 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242021501",
      "ndc_label_name": "Xolair Solution Prefilled Syringe 150 MG/ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242021401",
      "ndc_label_name": "Xolair Solution Prefilled Syringe 75 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242021403",
      "ndc_label_name": "Xolair Solution Prefilled Syringe 75 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242004086",
      "ndc_label_name": "Xolair Solution Reconstituted 150 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50242004062",
      "ndc_label_name": "Xolair SOLUTION RECONSTITUTED 150 MG Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090168300",
      "ndc_label_name": "Xulane Patch Weekly 150-35 MCG/24HR Transdermal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378334016",
      "ndc_label_name": "Xulane Patch Weekly 150-35 MCG/24HR Transdermal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00378334053",
      "ndc_label_name": "Xulane Patch Weekly 150-35 MCG/24HR Transdermal",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83257002411",
      "ndc_label_name": "Yesintek Solution 45 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83257002341",
      "ndc_label_name": "Yesintek Solution Prefilled Syringe 45 MG/0.5ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "83257002541",
      "ndc_label_name": "Yesintek Solution Prefilled Syringe 90 MG/ML Subcutaneous",
      "drug_tier": "Tier 1",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314031810",
      "ndc_label_name": "Zarxio Solution Prefilled Syringe 300 MCG/0.5ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314031805",
      "ndc_label_name": "Zarxio Solution Prefilled Syringe 300 MCG/0.5ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314031801",
      "ndc_label_name": "Zarxio Solution Prefilled Syringe 300 MCG/0.5ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314032605",
      "ndc_label_name": "Zarxio Solution Prefilled Syringe 480 MCG/0.8ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314032601",
      "ndc_label_name": "Zarxio Solution Prefilled Syringe 480 MCG/0.8ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "61314032610",
      "ndc_label_name": "Zarxio Solution Prefilled Syringe 480 MCG/0.8ML Injection",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "00276070830",
      "ndc_label_name": "Zeldana Capsule Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": true
    },
    {
      "ndc": "00053720102",
      "ndc_label_name": "Zemaira SOLUTION RECONSTITUTED 1000 MG Intravenous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "73562011101",
      "ndc_label_name": "Zenpep Capsule Delayed Release Particles 15000-47000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73562011201",
      "ndc_label_name": "Zenpep Capsule Delayed Release Particles 20000-63000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73562011601",
      "ndc_label_name": "Zenpep Capsule Delayed Release Particles 25000-79000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73562011301",
      "ndc_label_name": "Zenpep Capsule Delayed Release Particles 3000-10000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73562011401",
      "ndc_label_name": "Zenpep Capsule Delayed Release Particles 40000-126000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "73562011501",
      "ndc_label_name": "Zenpep Capsule Delayed Release Particles 5000-24000 UNIT Oral",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006307402",
      "ndc_label_name": "Zepatier TABLET 50-100 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00006307401",
      "ndc_label_name": "Zepatier TABLET 50-100 MG ORAL",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862010701",
      "ndc_label_name": "Zidovudine CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343004401",
      "ndc_label_name": "Zidovudine Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862004824",
      "ndc_label_name": "Zidovudine SYRUP 50 MG/5ML ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "31722050960",
      "ndc_label_name": "Zidovudine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862002460",
      "ndc_label_name": "Zidovudine TABLET 300 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52343004560",
      "ndc_label_name": "Zidovudine Tablet 300 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61314086601",
      "ndc_label_name": "Ziextenzo Solution Prefilled Syringe 6 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61314086602",
      "ndc_label_name": "Ziextenzo Solution Prefilled Syringe 6 MG/0.6ML Subcutaneous",
      "drug_tier": "Tier 2",
      "prior_authorization": true,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "77333098325",
      "ndc_label_name": "Zinc Sulfate CAPSULE 220 (50 Zn) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "77333098310",
      "ndc_label_name": "Zinc Sulfate CAPSULE 220 (50 Zn) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "20555004000",
      "ndc_label_name": "Zinc Sulfate Capsule 220 (50 Zn) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "37864099101",
      "ndc_label_name": "Zinc Sulfate Capsule 220 (50 Zn) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "68585000801",
      "ndc_label_name": "Zinc Sulfate Capsule 220 (50 Zn) MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "14428000611",
      "ndc_label_name": "Zinc-Oxyde Plus Ointment 0.44-20 % External",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": true
    },
    {
      "ndc": "60429076560",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714083501",
      "ndc_label_name": "Ziprasidone HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781216460",
      "ndc_label_name": "Ziprasidone HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342014409",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904626908",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904626945",
      "ndc_label_name": "Ziprasidone HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081111",
      "ndc_label_name": "Ziprasidone HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001045006",
      "ndc_label_name": "Ziprasidone HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135099160",
      "ndc_label_name": "Ziprasidone HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081112",
      "ndc_label_name": "Ziprasidone HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862070260",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090270400",
      "ndc_label_name": "Ziprasidone HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111025660",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762200101",
      "ndc_label_name": "Ziprasidone HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762100601",
      "ndc_label_name": "Ziprasidone HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180033107",
      "ndc_label_name": "Ziprasidone HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739098832",
      "ndc_label_name": "Ziprasidone HCl Capsule 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505252806",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 20 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010311",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010309",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 20 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904627045",
      "ndc_label_name": "Ziprasidone HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090542000",
      "ndc_label_name": "Ziprasidone HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090334900",
      "ndc_label_name": "Ziprasidone HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904627008",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135099260",
      "ndc_label_name": "Ziprasidone HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781216660",
      "ndc_label_name": "Ziprasidone HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429076660",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081211",
      "ndc_label_name": "Ziprasidone HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342014509",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714083601",
      "ndc_label_name": "Ziprasidone HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739000532",
      "ndc_label_name": "Ziprasidone HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081212",
      "ndc_label_name": "Ziprasidone HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010409",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505252906",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862070360",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001045106",
      "ndc_label_name": "Ziprasidone HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111025760",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 40 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010411",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762100801",
      "ndc_label_name": "Ziprasidone HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180033207",
      "ndc_label_name": "Ziprasidone HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762200201",
      "ndc_label_name": "Ziprasidone HCl Capsule 40 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342014609",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081311",
      "ndc_label_name": "Ziprasidone HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904627108",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111025860",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781216760",
      "ndc_label_name": "Ziprasidone HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081312",
      "ndc_label_name": "Ziprasidone HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762200301",
      "ndc_label_name": "Ziprasidone HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505253006",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904627145",
      "ndc_label_name": "Ziprasidone HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762101201",
      "ndc_label_name": "Ziprasidone HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010511",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739066632",
      "ndc_label_name": "Ziprasidone HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714083701",
      "ndc_label_name": "Ziprasidone HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429076760",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 60 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180033307",
      "ndc_label_name": "Ziprasidone HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135099360",
      "ndc_label_name": "Ziprasidone HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862070460",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001045206",
      "ndc_label_name": "Ziprasidone HCl Capsule 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010509",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 60 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781216860",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081412",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081411",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090292800",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714083801",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "33342014709",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904627208",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862070560",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135099460",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739050832",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111025960",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762101401",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721506",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335050102",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904627245",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764006",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721509",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001045306",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010611",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59762200401",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764003",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335072902",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090382300",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026301",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335050101",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68180033407",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788721503",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60429076860",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629691602",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60505253106",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 80 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788764009",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084010609",
      "ndc_label_name": "Ziprasidone HCl CAPSULE 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335050103",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026302",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335026303",
      "ndc_label_name": "Ziprasidone HCl Capsule 80 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00173044200",
      "ndc_label_name": "Zofran SOLUTION 40 MG/20ML INJECTION",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": false,
      "otc": false
    },
    {
      "ndc": "42291096430",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093007401",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440875510",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440875514",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440875507",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668000805",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781531810",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "12634094471",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024314",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440875530",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440875560",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668000810",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781531801",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063910",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291096401",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063901",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024360",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668000801",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714062202",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063915",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063960",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353056721",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291096410",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063906",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353056720",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668000815",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063921",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063930",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024320",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061721",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063063914",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024315",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061710",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714062201",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024310",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353056730",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024325",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999093102",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353056728",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024359",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061728",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024321",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024328",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353056762",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061707",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088014",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061714",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061740",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387801",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024330",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061759",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090263001",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061715",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088028",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061720",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387800",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407087830",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024345",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061760",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090607000",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061730",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088060",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999093100",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088015",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407094230",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024353",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700035730",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002050205",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061753",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002050220",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090102300",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088020",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111047901",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353056715",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862016001",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919066360",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061762",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002050230",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090102301",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088090",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118260506",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061725",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862016099",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629117101",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090607001",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760028860",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090263000",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187056560",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899902",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353061745",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788912709",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629961401",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111047905",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899903",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090580400",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187068230",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071069820",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407087810",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093015604",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544099640",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052730",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63739052610",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436000801",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899901",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071069830",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088030",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015228",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071069860",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052760",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335015401",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407087801",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205069130",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015230",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088045",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027315",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093015606",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919066330",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335015407",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407094201",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335015402",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019259",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "58118260503",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084845",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335015406",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919080330",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015210",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407094210",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019215",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027321",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760028830",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091514",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019228",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135077990",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019210",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088000",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027320",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027345",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187056530",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162198301",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019260",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "67544099626",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019253",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088002",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027325",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084828",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862016005",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032360",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027314",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071069814",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027328",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959088010",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084821",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084853",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071069810",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005902",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027360",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788912703",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084814",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002050210",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091515",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084860",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788912706",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005903",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084815",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335230301",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091525",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700035760",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091545",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091521",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027330",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "70518373900",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091510",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015215",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032301",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335015405",
      "ndc_label_name": "Zolpidem Tartrate TABLET 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091553",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091562",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027359",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019214",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091520",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015220",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032321",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019220",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091559",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026360",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084810",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019225",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420026330",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015221",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032330",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027353",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425005901",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425006102",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084820",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084825",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030103",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019230",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015303",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084830",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091528",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425006103",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032314",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425006001",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425006101",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610019245",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015302",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425015301",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030101",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027310",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425030102",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027362",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091530",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610091560",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789032315",
      "ndc_label_name": "Zolpidem Tartrate Tablet 10 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065210",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668000715",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440875402",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00093007301",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440875460",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440875430",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440875414",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781531701",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065214",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714062101",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291096330",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668000705",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291096310",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065260",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668000710",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00781531710",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024259",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065279",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065230",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "42291096301",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024230",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024214",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "16714062102",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00904608261",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062020",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024260",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024210",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065202",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059045",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024228",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059028",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "13668000701",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090102200",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059030",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024215",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063065221",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387904",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059059",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062045",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059010",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264901",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062053",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024245",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024220",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087915",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059060",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387902",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059053",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264904",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062059",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059007",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353024253",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087928",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062030",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087910",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436000701",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387900",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264903",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059015",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059014",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700026830",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062060",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111047805",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436000902",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090743400",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387903",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062010",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353059020",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687083801",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "49999093200",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052860",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407087710",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087914",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436000901",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062015",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062007",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687083811",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090102202",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919075120",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407094101",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087990",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407094110",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062028",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43353062014",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760076130",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090102204",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187055805",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55111047801",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002129201",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052830",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090102201",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264900",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919052820",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407087701",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071070330",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760051560",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002129203",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629354901",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090102203",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090264902",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62135077890",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407094130",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093015506",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919094860",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "55700026860",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629354904",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090387901",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087902",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187055860",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087920",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027228",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015128",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629354903",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084710",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50090580300",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "53002129202",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629354906",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087960",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027253",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090428",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862015901",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090445",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50436000702",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60760051530",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899801",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919075110",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067030",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016501",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071070314",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090453",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407087730",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919075160",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862015999",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187069160",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084730",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425051301",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071070345",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043001",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "52959087930",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187070760",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68071070360",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899802",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084745",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001460",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084018911",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629961301",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919075130",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629354902",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788912606",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68084018901",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090415",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629354905",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788885403",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788885406",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187055815",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "65862015905",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015645",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335962902",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425051302",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71093015504",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335962901",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015653",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187055830",
      "ndc_label_name": "Zolpidem Tartrate TABLET 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015115",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027210",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027259",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629899803",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015145",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015120",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084728",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788912603",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015160",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027215",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084760",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015628",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015610",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015130",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039030",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015630",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027220",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027245",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084715",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027214",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084720",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015153",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090410",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027230",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72162198201",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027260",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008702",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067053",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015615",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067060",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610067070",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090430",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610015620",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032201",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084753",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610027221",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090420",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084714",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72789039021",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610084721",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023330",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090414",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425016502",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71610090460",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032202",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76420023360",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425032203",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425008701",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043002",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425043003",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425051303",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "83008001430",
      "ndc_label_name": "Zolpidem Tartrate Tablet 5 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356014330",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440876260",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "60687023001",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919091760",
      "ndc_label_name": "Zonisamide CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300043001",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440876230",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081611",
      "ndc_label_name": "Zonisamide CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651038001",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919077590",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440876291",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919077530",
      "ndc_label_name": "Zonisamide CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578004201",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629329301",
      "ndc_label_name": "Zonisamide CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "50268081615",
      "ndc_label_name": "Zonisamide CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63629329302",
      "ndc_label_name": "Zonisamide CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919091730",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756026002",
      "ndc_label_name": "Zonisamide CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407013901",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462013005",
      "ndc_label_name": "Zonisamide CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788743801",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001024400",
      "ndc_label_name": "Zonisamide CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919077560",
      "ndc_label_name": "Zonisamide CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578004205",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919091790",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "63187089730",
      "ndc_label_name": "Zonisamide CAPSULE 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788400406",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "69097086107",
      "ndc_label_name": "Zonisamide CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71205072730",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462013001",
      "ndc_label_name": "Zonisamide CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425037001",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282022801",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039202",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001024403",
      "ndc_label_name": "Zonisamide CAPSULE 100 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788743803",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788743806",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68788743809",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "80425039201",
      "ndc_label_name": "Zonisamide Capsule 100 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756025802",
      "ndc_label_name": "Zonisamide CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300042801",
      "ndc_label_name": "Zonisamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356009330",
      "ndc_label_name": "Zonisamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356009390",
      "ndc_label_name": "Zonisamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462012801",
      "ndc_label_name": "Zonisamide CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356009301",
      "ndc_label_name": "Zonisamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440876091",
      "ndc_label_name": "Zonisamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "43063093230",
      "ndc_label_name": "Zonisamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189037472",
      "ndc_label_name": "Zonisamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407013701",
      "ndc_label_name": "Zonisamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356009360",
      "ndc_label_name": "Zonisamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001024200",
      "ndc_label_name": "Zonisamide CAPSULE 25 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282022601",
      "ndc_label_name": "Zonisamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651037801",
      "ndc_label_name": "Zonisamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578004001",
      "ndc_label_name": "Zonisamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "71335279802",
      "ndc_label_name": "Zonisamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72189062472",
      "ndc_label_name": "Zonisamide Capsule 25 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "76282022701",
      "ndc_label_name": "Zonisamide Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440876191",
      "ndc_label_name": "Zonisamide Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "29300042901",
      "ndc_label_name": "Zonisamide Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00440876160",
      "ndc_label_name": "Zonisamide Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "59651037901",
      "ndc_label_name": "Zonisamide Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "51407013801",
      "ndc_label_name": "Zonisamide Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919027560",
      "ndc_label_name": "Zonisamide CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919059160",
      "ndc_label_name": "Zonisamide CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61919074960",
      "ndc_label_name": "Zonisamide CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "62756025902",
      "ndc_label_name": "Zonisamide CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68462012901",
      "ndc_label_name": "Zonisamide CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "35356009430",
      "ndc_label_name": "Zonisamide Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "72578004101",
      "ndc_label_name": "Zonisamide Capsule 50 MG Oral",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "68001024300",
      "ndc_label_name": "Zonisamide CAPSULE 50 MG ORAL",
      "drug_tier": "Tier 1",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002763511",
      "ndc_label_name": "ZyPREXA Relprevv Suspension Reconstituted 210 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61269066020",
      "ndc_label_name": "ZyPREXA Relprevv Suspension Reconstituted 210 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61269066120",
      "ndc_label_name": "ZyPREXA Relprevv Suspension Reconstituted 300 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002763611",
      "ndc_label_name": "ZyPREXA Relprevv Suspension Reconstituted 300 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "00002763711",
      "ndc_label_name": "ZyPREXA Relprevv Suspension Reconstituted 405 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    },
    {
      "ndc": "61269066220",
      "ndc_label_name": "ZyPREXA Relprevv Suspension Reconstituted 405 MG Intramuscular",
      "drug_tier": "Tier 2",
      "prior_authorization": false,
      "step_therapy": false,
      "quantity_limit": true,
      "otc": false
    }
  ]
}